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Management of cardiovascular disease risk in chronic inflammatory disorders

Nature Reviews Rheumatology volume 5, pages 208–217 (2009)Cite this article

Abstract

Patients with chronic inflammatory disorders are at increased risk of developing premature cardiovascular disease. Despite significant advances in our understanding of the effects of inflammatory pathways on the vasculature, clear guidelines on the management of traditional and nontraditional cardiovascular risk factors in patients with systemic autoimmunity are lacking. Thus, rigorous studies assessing the individual contributions of the various treatments used in autoimmune disorders, as well as their effects on atherosclerosis development in these conditions, are needed. Furthermore, effective screening methods are needed to identify those patients with inflammatory disease who are at the highest risk for atherosclerotic complications, and who would benefit from early intervention. There is a clear need for a unifying explanation of the factors that promote premature cardiovascular disease in patients with chronic inflammatory disorders. Nevertheless, ongoing advances in the understanding of immune-mediated vascular damage mean that we are edging closer to the development of disease-specific preventive strategies to ameliorate or abrogate premature cardiovascular disease in these patients.

Key Points

  • Patients with systemic inflammatory diseases are at significantly increased risk of cardiovascular events, which contribute to the high morbidity and mortality associated with these diseases

  • Evidence suggests that rheumatoid arthritis and systemic lupus erythematosus are independent risk factors for the development of premature cardiovascular disease (CVD)

  • As factors promoting premature CVD-associated mortality might be present early in the natural history of inflammatory disease, preventive strategies to decrease cardiovascular risk should start shortly after diagnosis

  • Specific guidelines need to be developed that address the management of cardiovascular risk factors in rheumatoid arthritis, systemic lupus erythematosus and potentially other inflammatory conditions

  • Recent evidence suggests that optimal treatment of inflammatory disorders could result in improvements in vascular function and lead to decreases in the risk of CVD

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  1. MJ Kaplan, Division of Rheumatology, University of Michigan, 1150 W Medical Center Drive, 5520 MSRBI, Box 5680, Ann Arbor, MI 48109, USA makaplan@umich.edu

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  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Mariana J. Kaplan

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The author declared an association with the following company: Takeda Pharmaceutical. See article online for details of the relationship.

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Kaplan, M. Management of cardiovascular disease risk in chronic inflammatory disorders. Nat Rev Rheumatol 5, 208–217 (2009). https://doi.org/10.1038/nrrheum.2009.29

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