Unmet needs in the management of cardiovascular risk in inflammatory joint diseases

Castañeda, Santos; Vicente-Rabaneda, Esther F.; García-Castañeda, Noelia; Prieto-Peña, D.; Dessein, Patrick H

doi:10.1080/1744666x.2019.1699058

Cited by 19 publications

(16 citation statements)

References 127 publications

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“…In addition, there are other aspects contributing to cardiovascular risk in patients with chronic inflammatory rheumatic diseases, including organic diseases, psychological illnesses, socioeconomic factors, and miscellany conditions such as low vitamin D levels and hyperhomocysteinem. 81 Future study is needed to explore the association of more factors with the risk of MACEs in RA patients.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with risk of major adverse cardiovascular events in patients with rheumatoid arthritis: a nationwide, population-based, case-control study

Chen

Liu

Lai

et al. 2021

Therapeutic Advances in Musculoskeletal

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Objectives: To investigate factors associated with major adverse cardiovascular events (MACEs) in patients with rheumatoid arthritis (RA). Methods: We conducted a nationwide, population-based, case-control study using Taiwan’s National Health Insurance Research Database for 2003–2013. From 2004 to 2012, we identified 108,319 newly diagnosed RA patients without previous MACEs, of whom 7,580 patients (7.0%) developed MACEs during follow-up. From these incident RA patients, we included 5,994 MACE cases and 1:4 matched 23,976 non-MACE controls for analysis. The associations of MACEs with comorbidities and use of anti-rheumatic medications within 1 year before the index date were examined using conditional logistic regression analyses. Results: Using multivariable conditional logistic regression analysis, the risk of MACE in RA patients was associated with use of golimumab [odd’s ratio (OR), 0.09; 95% confidence interval (CI), 0.01-0.67], abatacept (OR, 0.13; 95% CI, 0.02–0.93), hydroxychloroquine (OR, 0.90; 95% CI, 0.82-0.99), methotrexate (OR, 0.72; 95% CI, 0.64–0.81), cyclosporin (OR, 1.43; 95% CI, 1.07–1.91), nonsteroidal anti-inflammation drugs (NSAIDs) (OR, 1.36; 95% CI, 1.27–1.46), antiplatelet agent (OR, 2.47; 95% CI, 2.31-2.63), hypertension (without anti-hypertensive agents: OR, 1.04; 95% CI, 0.96-1.12; with anti-hypertensive agents: OR, 1.47; 95% CI, 1.36-1.59), diabetes (OR, 1.27; 95% CI, 1.18-1.37), hyperlipidemia without lipid-lowering agents (OR, 1.09; 95% CI, 1.01-1.17), ischemic heart disease (OR, 1.20; 95% CI, 1.10-1.31), and chronic obstructive pulmonary disease (COPD) (OR, 1.12; 95% CI, 1.03-1.23) in the parsimonious model. The risk of MACE in RA patients also increased markedly in participants younger than 65 years with some comorbidities. Conclusions: This population-based case-control study revealed that the use of golimumab, abatacept, hydroxychloroquine, and methotrexate were associated with a decreased risk of MACE development in newly diagnosed RA patients, while the use of cyclosporin, NSAIDs, and antiplatelet agents, and comorbidities, including hypertension, diabetes, hyperlipidemia without lipid-lowering agent therapy, ischemic heart disease, and COPD, were associated with an increased risk of MACE development in RA patients.

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Section: Discussionmentioning

confidence: 99%

Factors associated with risk of major adverse cardiovascular events in patients with rheumatoid arthritis: a nationwide, population-based, case-control study

Chen

Liu

Lai

et al. 2021

Therapeutic Advances in Musculoskeletal

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“…The QRISK2 is the most widely used scale in the UK while the Framingham and American College of Cardiology/ American Heart Association (ACC/AHA) scale is more widely used in the US and Canada. In contrast to the SCORE scale, they establish the 10-year risk of major and non-major coronary events and classify patients into low (<10%), intermediate (10-20%), and high (20%) risk 3 . There is evidence that these algorithms (Framingham, ACC/AHA, and SCORE) underestimate because they do not include specific risk factors or overestimate (QRISK2) the true cardiovascular risk in patients with RA [2][3][4] .…”

Section: Identification Of Subclinical Atherosclerosis and Risk Stratificationmentioning

confidence: 99%

“…In contrast to the SCORE scale, they establish the 10-year risk of major and non-major coronary events and classify patients into low (<10%), intermediate (10-20%), and high (20%) risk 3 . There is evidence that these algorithms (Framingham, ACC/AHA, and SCORE) underestimate because they do not include specific risk factors or overestimate (QRISK2) the true cardiovascular risk in patients with RA [2][3][4] . For this reason, new tools have been developed to assess individual cardiovascular risk in patients with RA, such as the Extended Risk Score RA (ERS-RA).…”

Section: Identification Of Subclinical Atherosclerosis and Risk Stratificationmentioning

confidence: 99%

“…This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/). Immune-mediated chronic inflammatory diseases (IMIDs) include chronic inflammatory arthritis (mainly rheumatoid arthritis [RA], psoriatic arthritis [PsA], and spondyloarthritis [SpA]) and systemic autoimmune diseases (systemic lupus erythematosus [SLE], antiphospholipid syndrome (APS), systemic sclerosis (SSc), primary Sjögren syndrome (SS), and inflammatory myopathies, among others) 3 . Even in stages of disease remission or quiescence, there may be a degree of low-intensity inflammation and subclinical presentation.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular risk management in patients with immune-mediated inflammatory diseases

Garc�a-Gonz�lez¹,

Molina-Esteban²,

Galindo-Izquierdo³

2021

JIMIDS

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Cardiovascular morbidity and mortality are increased in immune-mediated inflammatory diseases (IMIDs). Among other factors, chronic inflammation appears to be a cornerstone in the development of cardiovascular disease. The usual risk stratification tools tend to underestimate risk in patients with inflammatory diseases. Treatments used for IMIDs have an impact on how vascular disease presents. Through a narrative review of the literature, we summarize strategies for the detection of subclinical cardiovascular disease (atherosclerosis) and individual risk stratification. We also review the presentation of cardiovascular disease in each of the IMIDs. Finally, we present strategies for the management of cardiovascular risk in these patients.

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“…Consequently, even if the findings of the Vergneault study 14 are confirmed in future larger and preferably longitudinal studies, the routine application of the DAS28-GGT is unlikely to significantly reduce the need for systematic formal CVD risk evaluation in RA. Moreover, besides the currently recommended need for consistent comprehensive traditional CVD risk factor recording in patients with RA, there is increasing evidence in support of a need for the complementary performance of noninvasive imaging, particularly carotid artery ultrasound, to optimize CV risk evaluation in many patients with RA 1,2,3,23 . This may be most important in RA patients from low or middle income populations such as black Africans in whom the Framingham score and SCORE are not useful in identifying high-risk atherosclerosis 2,24 .…”

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confidence: 99%

Could Disease Activity Score in 28 Joints–Gamma-glutamyl Transferase Use Improve Cardiovascular Disease Risk Management in Rheumatoid Arthritis?

2020

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Patients with rheumatoid arthritis (RA) experience a markedly increased risk of cardiovascular disease (CVD) 1,2,3. Atherogenesis in RA remains poorly elucidated but traditional cardiovascular (CV) risk factors, systemic inflammation and their interactions, as well as genetic components certainly contribute 1,2,3. In a recent 13-center study, the population-attributable CV event risk for disease activity as estimated by the Disease Activity Score in 28 joints (DAS28) and positive rheumatoid factor and/or anti cyclic citrullinated peptide antibodies, were both as large as that for lipids in RA 4. It is therefore not unexpected that current CVD risk stratification tools calculated based on major traditional CV risk factors, such as the Framingham score and Systematic Coronary Risk Evaluation (SCORE), perform suboptimally in RA 1,2,3. Recently developed disease-specific CVD risk calculators may also not perform better than those developed for the general population in predicting CV events in RA 5. In this regard, during the past 2 decades, many population studies revealed that circulating gamma-glutamyl transferase (GGT) concentrations within normal ranges relate to major traditional CV risk factors, systemic inflammation, and incident CV events 6,7,8,9,10,11,12. In RA, GGT levels were also found to be associated with disease activity markers 13. These reported observations suggest that serum GGT concentrations may be useful in the identification of patients with RA who are at increased CVD risk. In this issue of The Journal, Vergneault and colleagues 14 explored the associations of circulating GGT levels with CV risk factors in 129 patients with RA. Only patients with unstable hepatic disease and manifestations of liver dysfunction or failure were excluded. GGT concentrations were weakly associated with C-reactive protein (CRP) concentrations (r s 0.30, P = 0.002) but not with any other RA activity markers that are included in the DAS28 and comprise tender and swollen joint counts, global health or patient disease activity self-assessment, and the erythrocyte sedimentation rate (ESR). GGT levels were also not related to the Health Assessment Questionnaire-Disability Index, the presence of bone erosions, and ultrasound-determined synovitis. In contrast, GGT concentrations were associated with the nonmodifiable CV risk factors of age and male sex, as well as metabolic features including body weight, fasting glucose levels and diabetes, and dyslipidemia. Also, smokers (41%) were more likely to experience increased GGT concentrations compared to nonsmokers (25%), although this difference did not reach significance (P = 0.1). In line with these findings, GGT levels were increased in patients with metabolic syndrome and associated with the number of CV risk factors and Framingham score. Considering the reported associations of GGT concentrations with systemic inflammation and CV risk factors in non-RA persons, together with these current findings in RA, Vergneault and colleagues 14 constructed a DAS28 with inclusion of G...

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Unmet needs in the management of cardiovascular risk in inflammatory joint diseases

Cited by 19 publications

References 127 publications

Factors associated with risk of major adverse cardiovascular events in patients with rheumatoid arthritis: a nationwide, population-based, case-control study

Factors associated with risk of major adverse cardiovascular events in patients with rheumatoid arthritis: a nationwide, population-based, case-control study

Cardiovascular risk management in patients with immune-mediated inflammatory diseases

Could Disease Activity Score in 28 Joints–Gamma-glutamyl Transferase Use Improve Cardiovascular Disease Risk Management in Rheumatoid Arthritis?

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