Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment

Abstract

Patients with rheumatoid arthritis (RA) are at approximately 1.5-fold risk of atherosclerotic cardiovascular disease (CVD) compared with the general population, a phenomenon resulting from combined effects of traditional CVD risk factors and systemic inflammation. Rheumatoid synovitis and unstable atherosclerotic plaques share common inflammatory mechanisms, such as expression of proinflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF)-α and IL-6. RA patients are undertreated in terms of CVD prevention, and structured CVD prevention programmes are warranted. Alongside management of traditional risk factors, suppressing systemic inflammation with antirheumatic medication is fundamental for the reduction of CVD risk among this high-risk patient group. Many antirheumatic drugs, especially methotrexate, TNF-α-inhibitors and IL-6-inhibitors are associated with reduced risk of CVD in observational studies among RA patients, but randomised controlled trials with hard CVD endpoints are lacking. In patients without rheumatic disease, anti-inflammatory therapies targeting nucleotide-binding oligomerisation domain, leucine-rich repeat and pyrin domain-containing protein 3 inflammasome and the IL-1/IL-6 pathway arise as potential therapies after an atherosclerotic CVD event.

Association of atherogenic indices with C-reactive protein and risk factors to assess cardiovascular risk in rheumatoid arthritis patient at Tikur Anbessa Specialized Hospital, Addis Ababa

“…The C-reactive protein (CRP) is correlated with atherosclerotic plaque formation and rupture, which in turn increases disease activity and risk of CVD [ 11 , 15 , 16 ]. Therefore, the risk of CVD is elevated during the inflammatory conditions, which is mainly correlated with the development of atherosclerosis [ 17 ].…”

Prevalence and influence of hypouricemia on cardiovascular diseases in patients with rheumatoid arthritis

“…RA-related systemic inflammation plays important roles in determining cardiovascular risk and a complex relationship between LDL-C and cardiovascular risk [ 37 ]. Previous studies demonstrated that low LDL-C levels were connected to increased CVD risk in RA patients, and this connection was dubbed the "lipid paradox" [ 38 ].…”

Traditional and disease-related non-computed variables affect algorithms for cardiovascular risk estimation in Sjögren's syndrome and rheumatoid arthritis

“…Interestingly, the negative predictive role of bone erosions, an indirect marker of active disease, may suggest a potential beneficial effect of biologic anti-rheumatic therapies, more frequently used in patients with active and resistant disease. Convincing evidence supports that suppression of disease activity by anti-rheumatic therapies has fundamental role in lowering CV risk in RA patients (32). In this setting, the performance of CV algorithms as ERS-RA, which incorporate RA-specific factors as disease duration, disease activity and function, should be further evaluated in prospective studies with major clinical CV endpoints (33).…”