The jury is still out on just how cardiovascular risk should be screened for and managed in rheumatoid arthritis patients, but it is clear that the risk is increased and must be addressed.
In one study, silent myocardial infarction was shown to occur more often in RA patients than controls, and sudden death was also more likely in the RA patients (Arthritis Rheum. 2005;52:402-11). In another study, survival among patients with acute cardiac syndrome was substantially reduced in patients with RA versus those without (Ann. Rheum. Dis. 2006; 65:348-53).
The European League Against Rheumatism has proposed that conventional cardiovascular risk models be multiplied by 1.5 when assessing risk in RA patients (Ann. Rheum. Dis. 2010;69:325-31). This approach is not well validated, and Dr. Joan Bathon, director of the division of rheumatology at Columbia University, New York, said she is not sure it is being widely used at this point.
The proposal illustrates the importance of focusing on cardiovascular risk in RA patients, and it suggests that considering RA as a risk factor equivalent to diabetes mellitus – at least for decision making regarding low-density lipoprotein goals – is a reasonable strategy, Dr. Bathon said at the annual congress of clinical rheumatology.
She also said a potential screening strategy involves yearly cardiovascular risk assessments. The benefits of using imaging and biomarkers for screening are unclear, and no guidelines are currently in place, but some data suggest that the use of carotid ultrasound scans to look for plaques and to assess intima-media thickness, and the calculation of a coronary artery calcium score calculated on computed tomography findings may be useful in patients over age 40 years.
As for potential management strategies, aspirin therapy might be beneficial, but it should be considered in the context of other medications the patient is taking. Statins are also a potential management tool, but questions remain about whether all RA patients should be treated regardless of LDL level, she said.
Definite treatment strategies for RA patients include weight management for overweight patients, which will help reduce inflammation, and exercise for all RA patients, because good quality muscle building will help restore insulin sensitivity and reduce fat deposits that are the most inflammatory. Tight blood pressure control and tight RA control are also imperative, she said.
Dr. Bathon had no relevant disclosures.