ReviewCardiovascular risk in rheumatoid arthritis
Section snippets
Epidemiological data
Excess mortality has been convincingly documented in patients with RA compared to the general population [1]. Cardiovascular disease explained about 50% of the excess mortality in RA patients in a meta-analysis of 24 mortality rate studies published between 1970 and 2005 [2]. Both cardiac and cerebrovascular events contributed to the excess mortality, in both females and males [2]. The relationship between disease duration and cardiovascular risk remains debated. A meta-analysis found no
Pathophysiology
Conventional risk factors, which are best evaluated using cardiovascular risk equations, are more common in RA but do not fully explain the increased cardiovascular risk [4], as adjusting for conventional cardiovascular risk factors induces only a very small decrease in the relative risk (RR) of cardiovascular events in RA patients [4], [5], [6]. Proinflammatory cytokines (IL-1, TNF-α, IL-6, and IL-17) promote atherogenesis and may explain the increased development of atheroma in RA [11]. Thus,
Cardiovascular risk management
Recommendations for cardiovascular risk management in RA were issued recently (Table 1) [31].
Conclusion
RA is undoubtedly a risk factor for cardiovascular disease. Although the pathophysiological mechanisms underlying this effect remain unclear, rigorous disease activity control combined with careful minimization of all conventional cardiovascular risk factors are crucial.
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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