Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases

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.

Comparison of CVD Risk Assessment via Qrisk®2 vs Reynolds Risk Score in Inflammatory Joint Diseases

“…It is not easy to diagnose cardiovascular disease in these patients because of atypical symptom, asymptomatic patients, and misinterpretation of chest pain by the rheumatologist and presence of a high inflammatory state. 5 Furthermore, no proper cardiovascular risk prevention guidelines exist for patients with inflammatory joint disease resulting in inability to offer prevention strategies to those who may need it in this patient population. The absence of mandatory regular follow-up visits for these patients also hampers early cardiovascular disease detection in these patients.…”

“…Since the data for the original risk assessment tools, was not obtained from patients with inflammatory joint disease, questions have been raised over the validity of these risk stratification systems in these patients. 5 The study population for QRISK ® 2 study had endemic rheumatoid arthritis, therefore, it was included as an independent risk factor for coronary artery disease. The Reynolds Risk Score uses CRP values, though the values used in the score are not as high as those found generally in these patients.…”

“…4 Therefore, estimating the prevalence of cardiovascular disease is an important first step towards cardiovascular disease risk stratification of an individual. 5 The risk of coronary artery disease in an individual with inflammatory joint diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic lupus erythematosus etc., depends on the presence of traditional and non-traditional risk factors of cardio-vascular disease. [6][7][8] The traditional risk factors include tobacco smoking, sex, age, diabetes mellitus, hypertension, obesity, family history of ischemic heart disease and dyslipidemias 6,7 and the nontraditional risk factors for cardiovascular disease include genetic susceptibility, chronic inflammation and chronic use of medication for disease control.…”

“…15 The assessment of cardiovascular risk is well-established in inflammatory joint diseases such as rheumatoid arthritis and several algorithms such as the Framingham Risk Score, the QRISK®2 & QRISK®3, the SCORE chart and the Reynolds Risk Score have been developed and validated for assessment of cardiovascular risk in patients with inflammatory joint diseases such as rheumatoid arthritis. 5 The aim of the study was cardiovascular risk stratification in patients with inflammatory joint disease and comparison of QRISK®2 risk score with the Reynolds Risk Score in our population. Considering the paucity of information in literature on this topic, we believe that the results of this study would establish a foundation of future research.…”

A Review of the Role of Transthoracic and Transesophageal Echocardiography, Computed Tomography, and Magnetic Resonance Imaging in Cardioembolic Stroke

“…In people with AF, the CHADS2 hazard assessment approach is widely used to determine the risk of stroke. Those with valvular AF face a 2- to 7-fold greater risk [ 4 – 6 , 8 , 10 , 11 ].…”