Risk Factors for Cardiovascular Disease in Rheumatoid Arthritis: Defining Treatment Thresholds

Abstract

To the Editor: We read with interest the very insightful editorial by Dessein, et al 1 on the determinants of dyslipidemia in rheumatoid arthritis (RA) in a recent issue of The Journal. There is little doubt that dyslipidemia participates in the atherogenesis of RA even when the disease is treated with disease-modifying antirheumatic drugs (DMARD), and its determinants comprise more of the conventional dyslipidemia risk factors than RA characteristics1. The question is how to best define the thresholds for conventional risk factors where interventions would be necessary. Although cardiovascular disease (CVD) is highly prevalent in RA, identification is often difficult on clinical grounds alone, especially where reduced physical exertion and symptoms of CVD may be attributed to musculoskeletal rather than cardiac causes2. Further, it may be clinically silent in many patients, emphasizing the need for a high degree of … Address correspondence to Dr. V. Ravindran; E-mail: drvinod12{at}gmail.com