SAN FRANCISCO — Patients who have rheumatoid arthritis should be assessed annually for cardiovascular risk factors, a recommendation necessitated by a heart disease risk profile that equates to that of those with type 2 diabeties, a European task force concluded.
“Cardiovascular risk management is urgently needed for patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis,” said Dr. Michael T. Nurmohame, who was speaking on behalf of the European League Against Rheumatism cardiovascular disease risk management task force at the annual meeting of the American College of Rheumatology.
Task force recommendations highlighted at the meeting included:
▸ Characterizing of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis as “high-risk” conditions with regard to cardiovascular disease, similar to diabetes.
▸ Launching annual screening for cardiovascular risk of every RA patient, with consideration of screening of ankylosing spondylitis and psoriatic arthritis patients as well.
▸ Providing every patient with lifestyle recommendations for lowering cardiovascular risk.
▸ Emphasizing aggressive control of disease activity to suppress inflammation and lower cardiovascular risk.
▸ Adapting cardiovascular risk scoring models (such as the newly adapted Systematic Coronary Risk Evaluation SCORE) by a factor of 1.5 to account for elevated baseline risk associated with inflammatory rheumatic diseases.
▸ Considering of treatment with statins and/or antihypertensive drugs according to cardiovascular management targets established by local guidelines; or, if no local guidelines exist, when targets exceed 10-year cardiovascular mortality risk models established in the newly adapted SCORE.
▸ Acknowledging that the role of cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory drugs is not well established in RA patients.
▸ Limiting corticosteroids to the lowest possible doses.
The task force consisted of 21 rheumatologists, internists, cardiologists, and epidemiologists representing nine European countries.
Its work was prompted by the increasing recognition that those patients who have rheumatoid arthritis face a steeply elevated risk in cardiovascular diseases, said Dr. Nurmohamed, who is a rheumatologist at the VU University Medical Center and Jan van Breemen Institute in Amsterdam.
The risk can only be partially explained by traditional risk factors, with inflammatory processes serving as the apparent “missing link,” he suggested.
Earlier this year, Dr. Nurmohamed and his associates published the results of the CARRÉ study, in which they compared cardiovascular risk in 353 patients with rheumatoid arthritis with two groups of similarly aged patients who were enrolled in the population-based Hoorn cohort study: 194 of the patients had type 2 diabetes and 258 healthy controls (Ann. Rheum. Dis. 2008 Aug. 12 [doi:10.1136/ard.2008.094151]).
The prevalence of cardiovascular disease was 5% in nondiabetic patients with no rheumatoid arthritis; 12.4% in patients with type 2 diabetes; and 12.9% in patients with RA.
Some of that risk can be accounted for by increased hypertension, dyslipidemia, and lifestyle factors in the RA population, he said.
However, inflammatory rheumatic diseases themselves also seem to confer an independent risk that should be accounted for in models that predict cardiovascular mortality, Dr. Nurmohamed commented.