Cardiovascular Risk Assessment in Patients with Rheumatoid Arthritis.

Background/

Objectives

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by inflammation of the synovium. The inflammation accelerates the development and progression of atherosclerosis, a key phenomenon in the onset of cardiovascular diseases. The aim of this review was to synthetize the traditional and RA-specific cardiovascular risk (CVR) factors and the CVR assessment guidelines in RA patients.

Methods

We performed a PubMed search using specific keywords. We synthetized the main findings.

Results

Although the risk factors are the traditional ones, with certain particularities, the mechanisms that lead to cardiovascular disease are distinguished. In RA, the "lipid paradox" occurs: low levels of total cholesterol and low-density lipoprotein (LDL)-cholesterol, and high levels of high-density lipoprotein (HDL)-cholesterol. Despite this phenomenon, patients have an elevated risk of cardiovascular events. This is due to inflammation, which increases cholesterol catabolism and interferes with the anti-oxidant properties of HDL-cholesterol. There is a significant association between serum C-reactive protein (CRP) value and cardiovascular risk: each 20 mg/L increase in CRP causes a 1% increase in cardiovascular risk. The evaluation of the CVR through standard matrices undervalues the risk in patients with RA. Various approaches have been suggested to improve the accuracy of cardiovascular risk appraisal: from multiplying standard scores, including specific biomarkers, to modifying the impact of certain parameters in risk calculation.

Conclusions

RA inflammatory and autoimmune mechanisms increase the cardiovascular morbidity and mortality in this group of patients. Therefore, this category of patients requires a proper cardiovascular (CV) evaluation. Carotid ultrasound ensures a better classification of RA patients, especially women, in the cardiovascular risk categories.