[Cardiovascular risk in inflammatory rheumatic diseases : Evidence-based strategies for risk reduction in...

Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) have a persistently increased cardiovascular (CV) risk and higher mortality, independently of traditional CV risk factors. Effective control of inflammation reduces CV events, whereas glucocorticoids increase the risk in a dose- and duration-dependent manner, even at ≤ 5 mg prednisolone/day. Disease-modifying antirheumatic drugs especially tumor necrosis factor (TNF) inhibitors, are largely protective through the reduction of systemic inflammation. For patients receiving Janus kinase (JAK) inhibitors or long-term glucocorticoid therapy, a structured CV risk assessment and guideline-based management of modifiable risk factors (including lipid optimization/statin therapy) are essential. Primary prevention should be based on the cardiovascular prevention guidelines of the European Society of Cardiology (ESC). Vaccinations (influenza, COVID-19, pneumococcus, respiratory syncytial virus, zoster) represent an effective pillar of CV prevention in populations at cardiovascular risk; however, evidence in patients with inflammatory rheumatic diseases is still lacking. The main challenge for CV prevention remains implementation: digital clinical reminders/decision support systems and multicomponent strategies can improve the implementation of recommendations.