Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

• Published in: BMJ (Online) Vol. 361; p. k1036
• Main Authors: England, Bryant R, Thiele, Geoffrey M, Anderson, Daniel R, Mikuls, Ted R
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 23.04.2018; British Medical Journal Publishing Group
• Series: State of the Art Review
• Subjects: Arthritis, Rheumatoid - epidemiology; Arthritis, Rheumatoid - immunology; Arthritis, Rheumatoid - therapy; Autoimmunity; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - immunology; Cardiovascular Diseases - prevention & control; Clinical Review; Confidence intervals; Exercise; Health risk assessment; Humans; Hypertension; Hypotheses; Immune response; Inflammation; Lipoproteins; Medical prognosis; Morbidity; Mortality; Oxidative stress; Patient Care Management; Physical fitness; Post-translation; Rheumatoid arthritis; Rheumatology; Risk Assessment; Risk Factors; Smoking; United States > US
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.k1036

ABSTRACTRheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.