Need for Improved CVD Prevention in Patients With RA

Patients with rheumatoid arthritis (RA) have a higher risk of cardiovascular disease (CVD), because inflammation plays a pivotal role in the development of CVD. However, there is a need for greater improvement of CVD risk prevention. A review published in Nature Reviews Rheumatology provided an analysis of what is known about atherosclerotic CVD in patients with RA and what needs to be clarified in recommendations for CVD prevention in these patients. “Although this high risk of CVD has been known for decades, patients with RA receive poorer primary and secondary CVD preventive care than other high-risk patients, and an unmet need exists for improved CVD preventive measures for patients with RA,” the authors explained. In the United States, there are no RA-specific recommendations for CVD risk prediction, but the European League Against Rheumatism (EULAR) does recommend that patients with RA are screened every 5 years for CVD risk factors. According to the authors, CVD risk calculators that are used in the general population can inaccurately predict CVD in patients with RA. EULAR recommends that cardiovascular risk estimations for patients with RA use a 1.5 multiplication factor to the Systematic Coronary Risk Evaluation risk estimate. The authors noted that ultrasonography of the carotid arteries can identify atherosclerotic plaques, thereby improving CVD risk classifications in patients with RA. They also highlighted that there are some specific drug–drug interactions providers should be aware of in patients with RA. However, there is limited evidence on interactions of antirheumatic drugs and lipid-lowering drugs. Doses of statins or antihypertensive medications used to attain recommended lipid or blood pressure goals are not affected by inflammation and antirheumatic medications used in patients with RA. The authors recommended further studies on the use of monoclonal antibodies and conventional synthetic disease-modifying antirheumatic drugs and their impact on the development of CVD in patients with RA. Reference Semb AG, Ikdahl E, Wibetoe G, Crowson C, Rollefstad S. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nature Reviews Rheumatology. Published online June 3, 2020. doi:10.1038/s41584-020-0428-y