Cardiovascular risk in rheumatoid arthritis: An update for general practitioners

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory articular pathology which affects almost 1% of the general population and which is ranked among the top 15% of diseases causing major disability worldwide. RA shares some pathologic features, genetic predisposition and risk factors with atherosclerosis. Inflammation plays a central pathophysiologic role in both diseases. As compared with the general population, in RA the prevalence of cardiovascular events is increased to an extent comparable to that of type 2 diabetes mellitus. RA-Patients have a higher incidence of myocardial ischemia and infarction, cardiac failure, valvular heart disease, pericarditis, myocarditis and, to a lesser extent, venous complications. The occurrence of sudden cardiac death is two-fold increased and that of major adverse cardiovascular events is augmented to almost 50%. Cardiovascular deaths increase seven years following symptoms onset. Control of the joint pathology remains the principal therapeutic aim in RA, but the impact of cardiovascular complications should not be forgotten. Patients with RA who are at high cardiovascular risk should be given the best available therapies to reduce the cardiovascular complications. There are things we know that we know. There are known unknowns. That is to say, there are things that we know that we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know. Donald Rumsfeld