Managing Cardiovascular Risk Essential in People With RA
Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients should undergo compulsory cardiovascular (CV) risk management and existing CV risk calculators should be adapted to the increased CV risk in inflammatory rheumatic disease patients, according to the European League Against Rheumatism Task Force on “Cardiovascular Risk Management in RA.”
RA, AS and PsA are associated with an increased CV risk and, in RA, this risk is at least double the norm and potentially similar to that of type 2 diabetes. The EULAR Task Force set out to review existing evidence and expert opinion-based recommendations on CV management in inflammatory rheumatic disease to devise these specific recommendations.
- RA, AS and PsA should become clinically accepted as new CV risk factors.
- Existing CV-risk calculators, such as the Framingham and Systematic Coronary Risk Evaluation (SCORE), should be adapted, by a multiplier, to reflect the increased CV risk in inflammatory rheumatic disease patients.
- Annual cardiovascular risk screening is recommended for all RA patients and should be considered for AS and PsA patients.
- Lifestyle recommendations (on areas including diet, exercise, smoking cessation and stress management) should be given to all inflammatory rheumatic disease patients.
- Treatment with statins and/or antihypertensives should be considered, and the CV management targets should be set according to local guidelines. If there are no local guidelines, treatment should be considered when the 10 year CV mortality risk with the (newly adapted) Framingham/SCORE function is above a certain value.
- Aggressive inflammation suppression is recommended to further lower the CV risk in patients with inflammatory rheumatic disease.
Dr. Michael Nurmohamed, lead investigator said, "Although traditional cardiovascular risk factors occur more frequently in patients with inflammatory rheumatic disease than in the general population, they only partially explain these patients' increased cardiovascular risk. There is mounting evidence that inflammation may be the missing link. Therefore, disease modifying antirheumatic drugs (DMARD) and biologics may lower the cardiovascular risk in inflammatory rheumatic disease patients, whilst statins and hypertensives, such as ACE inhibitors and angiotensin blockers, may even yield greater benefits than in the general population due to their anti-inflammatory properties."
This article was adapted from a press release issued by EULAR.