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Published on: September 26, 2018
Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases
Abhinav Sharma1,2, Ruxandra Christodorescu3,4, Ahmad Agbariah5
1Department Cardiology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Insights
Cardiovascular disease (CVD) risk is elevated in rheumatic disease patients. This review highlights improved risk prediction parameters and management strategies, emphasizing the need for better CVD risk stratification models in this population.
Area of Science:
- Cardiology
- Rheumatology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) poses a higher risk for patients with rheumatic diseases compared to the general population.
- Current methods for identifying and assessing CVD risk in rheumatic patients are inadequate and have limited clinical utility.
- Early detection and effective management of CVD are crucial in preventive cardiology.
Purpose of the Study:
- To review and describe updated cardiovascular risk prediction parameters for individuals with rheumatic diseases.
- To evaluate current therapeutic and risk management strategies for CVD in this patient group.
- To identify the need for improved CVD risk stratification models in rheumatic disease patients.
Main Methods:
- A narrative review of relevant literature.
- Screening of PUBMED, Scopus, and Google Scholar databases for articles published between 2011 and 2021.
- Selection of 47 English-language full-text articles, including RCTs and reviews.
Main Results:
- Advanced imaging techniques (ECG, ultrasound, cIMT) and biomarkers (osteoprotegerin, angiopoietin-2) aid in CVD risk prediction and early diagnosis.
- Physical exercise is a beneficial non-pharmacological intervention for cardiovascular health and underlying rheumatic disease.
- While some disease-modifying antirheumatic drugs (DMARDs) like methotrexate and anti-TNF agents may lower CV risk, anti-TNF therapy can negatively impact cardiac function in heart failure patients.
- Glucocorticoids, NSAIDs, and COX-2 inhibitors are associated with increased CVD risk.
Conclusions:
- There is a significant need for the development and implementation of robust CVD risk stratification models tailored for patients with rheumatic diseases.
- Integrating advanced diagnostic tools and considering medication-specific cardiovascular effects is essential for managing CVD risk.
- Multifaceted approaches combining pharmacological and non-pharmacological interventions are necessary for comprehensive cardiovascular care in rheumatic disease patients.
Abstract:
The early detection of cardiovascular disease (CVD) serves as a key element in preventive cardiology. The risk of developing CVD in patients with rheumatic disease is higher than that of the general population. Thus, the objective of this narrative review was to assess and describe updated risk-prediction parameters for CVD in patients suffering from rheumatic diseases, and, additionally, to evaluate therapeutic and risk management possibilities. The processes of recognizing CVD risk factors in rheumatic diseases, establishing diagnoses, and discovering CV risk assessments are currently displeasing in clinical practice; they have a limited clinical impact. A large number of references were found while screening PUBMED, Scopus, and Google scholar databases; the 47 most relevant references were utilized to build up this study. The selection was limited to English language full text articles, RCTs, and reviews published between 2011 and 2021. Multiple imaging techniques, such as ECG, ultrasound, and cIMT, as well as biomarkers like osteoprotegerin cytokine receptor and angiopoietin-2, can be beneficial in both CV risk prediction and in early subclinical diagnosis. Physical exercise is an essential non-pharmacological intervention that can maintain the health of the cardiovascular system and, additionally, influence the underlying disease. Lipid-lowering drugs (methotrexate from the non-biologic DMARDs family as well as biologic DMARDs such as anti-TNF) were all associated with a lower CV risk; however, anti-TNF medication can decrease cardiac compliance and promote heart failure in patients with previously diagnosed chronic HF. Although they achieved success rates in reducing inflammation, glucocorticoids, NSAIDs, and COX-2 inhibitors were correlated with an increased risk of CVD. When taking all of the aforementioned points into consideration, there appears to be a dire need to establish and implement CVD risk stratification models in rheumatic patients.
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