Management of cardiovascular risk in patients with rheumatoid arthritis: evidence and expert opinion

Oever, I A M van den; Sijl, A.M. van; Nurmohamed, Michael T.

doi:10.1177/1759720x13491025

Cited by 43 publications

(30 citation statements)

References 133 publications

(167 reference statements)

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“…Of note is that we need a more stringent control for DL, as ethnic variation in lipid profile is responsible for increased CVD risk and the high inflammatory state in RA patients, as this disease itself accentuates atherosclerosis. Patients with RA might benefit from being targeted with stricter than conventional CVD risk prevention and intervention 21,22. Evidence suggests that lipid lowering therapy may have beneficial effects in RA by virtue of their potent anti-inflammatory and immune-modulatory properties also 23.…”

Section: Discussionmentioning

confidence: 99%

Lipid abnormalities in patients with Rheumatoid Arthritis

Erum¹,

Ahsan²,

Khowaja³

2017

Pak J Med Sci

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Objective:To determine the frequency of dyslipidemia in patients with Rheumatoid Arthritis.Methods:This is a prospective, cross-sectional, observational study, conducted at the ‘Rheumatology Clinic’ of Jinnah Postgraduate Medical Center (JPMC), Karachi, from November 2013 to May 2014. A total of 200 patients of Rheumatoid Arthritis (RA), diagnosed according to the ACR/EULAR criteria 2010, were included in the study. Laboratory investigations including creatinine, ALT, CBC, TSH and fasting lipid profile (LDL, HDL, and Total cholesterol) were done for all patients.Results:Out of 200 patients, 23 (11.5%) were male and 177 (88.5%) were female. The mean age was 36.31±10.46 years and the mean duration of disease was 3.82±3.03 years. A total of 107 (53.5%) patients had dyslipidemia, and the commonest abnormality was a low HDL, seen in 83 (41.5 %) patients.Conclusion:Dyslipidemia was frequently observed in Rheumatoid Arthritis. This may be considered as a secondary impact of chronic inflammatory state, seen in RA. Lipid abnormalities should be sought at regular intervals, and corrective actions taken to mitigate increased cardiovascular disease risk.

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Section: Discussionmentioning

confidence: 99%

Lipid abnormalities in patients with Rheumatoid Arthritis

Erum¹,

Ahsan²,

Khowaja³

2017

Pak J Med Sci

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“…Insulin resistance often precedes diabetes, but an association between RA and diabetes is not evident. 52 Control of inflammation with potent anti-inflammatory therapies, such as anti-TNF agents, seems to reverse insulin resistance only in patients with RA who are not obese, suggesting that inflammation and BMI are both important contributors to insulin resistance in this population. 53 Anti-inflammatory agents can also be effective in preventing diabetes, and in a study of patients with RA or psoriasis, the risk of newly recorded diabetes was lower for individuals initiating therapy with a TNF inhibitor or hydroxychloroquine compared with other nonbiologic DMARDs.…”

Section: Body Weight and Physical Inactivitymentioning

confidence: 99%

Cardiovascular comorbidity in rheumatic diseases

2015

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Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity.

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“…The reasons for this remain unclear but it may simply be a reflection of what looks like a better lipid profile at disease onset reducing the apparent urgency of repeated lipid testing. The increased morbidity and mortality is thought to arise not just from traditional CV risk factors such as hypertension, smoking and obesity but also from a chronic inflammatory state [18]. Although RA is included as an independent risk factor in some cardiovascular risk calculators, and EULAR recommends an increased numerical weighting for assessing cardiovascular risk in RA [19], the overall performance of readily available risk algorithms in predicting CV events in patients with early RA is variable [20•].…”

Section: Cardiovascular Disease In Ramentioning

confidence: 99%

Lipid and Metabolic Changes in Rheumatoid Arthritis

McGrath

Young

2015

Curr Rheumatol Rep

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While the most obvious manifestations of rheumatoid arthritis (RA) involve inflammation and damage in the synovial joints, the systemic effects of the condition are widespread and life-threatening. Of particular interest is the 'lipid paradox' of RA, where patients with a numerically equivocal starting lipid profile have a significantly raised risk of cardiovascular (CV) events and response to therapy results in a 'normalization' of lipid levels and reduction in events. Changes in lipids can be seen before overt disease manifestations which suggest that they are closely linked to the more widespread inflammation-driven metabolic changes associated with tumour necrosis factor (TNF). Cachexia involves a shift in body mass from muscle to fat, which may or may not directly increase the cardiovascular risk. However, since TNF inhibition is associated with reduction in cardiovascular events, it does suggest that these widespread metabolic changes involving lipids are of importance. Analysis of single lipids or metabolites have been used to identify some of the key changes, but more recently, metabolomic and lipidomic approaches have been applied to identify a broad spectrum of small molecule changes and identify potentially altered metabolic pathways. Further work is needed to understand fully the metabolic changes in lipid profiles and identify novel ways of targeting desired profile changes, but work so far does suggest that a better understanding may allow management of patients to downregulate the systemic effects of their disease that puts them at risk of cardiovascular complications.

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Management of cardiovascular risk in patients with rheumatoid arthritis: evidence and expert opinion

Cited by 43 publications

References 133 publications

Lipid abnormalities in patients with Rheumatoid Arthritis

Lipid abnormalities in patients with Rheumatoid Arthritis

Cardiovascular comorbidity in rheumatic diseases

Lipid and Metabolic Changes in Rheumatoid Arthritis

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