RT Journal Article
SR Electronic
T1 Atherosclerotic cardiovascular disease in patients with chronic inflammatory joint disorders
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 790
OP 795
DO 10.1136/heartjnl-2015-307838
VO 102
IS 10
A1 R Agca
A1 S C Heslinga
A1 V P van Halm
A1 M T Nurmohamed
YR 2016
UL http://heart.bmj.com/content/102/10/790.abstract
AB Inflammatory joint disorders (IJD), including rheumatoid arthritis (RA), ankylosing spondylitis (ASp) and psoriatic arthritis (PsA), are prevalent conditions worldwide with a considerable burden on healthcare systems. IJD are associated with increased cardiovascular (CV) disease-related morbidity and mortality. In this review, we present an overview of the literature. Standardised mortality ratios are increased in IJD compared with the general population, that is, RA 1.3–2.3, ASp 1.6–1.9 and PsA 0.8–1.6. This premature mortality is mainly caused by atherosclerotic events. In RA, this CV risk is comparable to that in type 2 diabetes. Traditional CV risk factors are more often present and partially a consequence of changes in physical function related to the underlying IJD. Also, chronic systemic inflammation itself is an independent CV risk factor. Optimal control of disease activity with conventional synthetic, targeted synthetic and biological disease-modifying antirheumatic drugs decreases this excess risk. High-grade inflammation as well as anti-inflammatory treatment alter traditional CV risk factors, such as lipids. In view of the above-mentioned CV burden in patients with IJD, CV risk management is necessary. Presently, this CV risk management is still lacking in usual care. Patients, general practitioners, cardiologists, internists and rheumatologists need to be aware of the substantially increased CV risk in IJD and should make a combined effort to timely initiate CV risk management in accordance with prevailing guidelines together with optimal control of rheumatic disease activity. CV screening and treatment strategies need to be implemented in usual care.