Atherosclerotic cardiovascular disease in rheumatoid arthritis

Abstract

The past 3 years have seen a remarkable growth in the interest of cardiovascular disease in rheumatoid arthritis. There have been studies published documenting an increased incidence and prevalence of cardiovascular conditions in patients with rheumatoid arthritis compared with individuals without rheumatoid arthritis. There has also been interest in the occurrence of cardiovascular risk factors in rheumatoid arthritis and in the role of antirheumatic therapy, including cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs, methotrexate, corticosteroids, and tumor necrosis factor inhibitors. A number of studies using noninvasive means to detect atherosclerosis have shown that patients with rheumatoid arthritis may be prone to atherosclerosis. This information should be important to physicians who provide care to patients with rheumatoid arthritis, given the difficulty of recognizing cardiovascular signs and symptoms among patients with the disease.

Leg Ulceration in Rheumatoid Arthritis – An Underreported Multicausal Complication with Considerable Morbidity: Analysis of Thirty-Six Patients and Review of the Literature

“…RA patients tend to have an increased risk of developing atherosclerosis due to the disease itself and the long-standing immunosuppressive therapy with corticosteroids leading to increased morbidity by coronary, cerebral and PAD [25,26]. Relevant PAD is considered in patients with an ankle-brachial index <0.9 [27].…”

Vascular endothelial growth factor A and cardiovascular disease in rheumatoid arthritis patients

“…Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with an accelerated atherosclerosis (24, 25), which is responsible for an increased cardiovascular (CV) morbidity and mortality (26). The chronic systemic inflammatory status, independent of the traditional CV risk factors, plays a pivotal role in the development of the accelerated atherogenesis observed in the patients with RA (24, 27–30). Interestingly, elevated levels of VEGF have been observed in the serum of patients with RA (31) and these levels seem to be correlated with the severity of the disease (32).…”

Preliminary Report of Endovascular Treatment for Critical Limb Ischemia Patients with Connective Tissue Disease: Cases Series and Review of the Literature

“…9,26 Also, it has been reported that patients with RA have mortality rates higher than those of the general population, with most deaths due to complications of arteriosclerosis. 10,29,30 Patients with RA were also found to have increased intima-media thicknesses, a factor strongly associated with adverse cardiovascular events. 29 A meta-analysis by Tyrrell et al 7 showed that patients with rheumatic disease have a higher occurrence of atherosclerosis as determined by ultrasonographically measured intima-media thickness.…”

“…10,29,30 Patients with RA were also found to have increased intima-media thicknesses, a factor strongly associated with adverse cardiovascular events. 29 A meta-analysis by Tyrrell et al 7 showed that patients with rheumatic disease have a higher occurrence of atherosclerosis as determined by ultrasonographically measured intima-media thickness. Therefore, when treating such patients, clinicians should address their increased risk of atherosclerosis and cardiovascular disease by making efforts to mitigate cardiovascular risk factors and control disease symptoms, including inflammation.…”