Abstract
Rheumatoid arthritis (RA) is an autoimmune, inflammatory disorder associated with excess cardiovascular morbidity and mortality. A complex interplay between traditional risk factors (dyslipidemia, insulin resistance, arterial hypertension, obesity, smoking) and chronic inflammation is implicated in the development of premature atherosclerosis and consequently in the higher incidence of cardiovascular events observed in RA patients. Despite the acknowledgment of elevated cardiovascular risk among RA individuals, its management remains suboptimal. While statin administration has a crucial role in primary and secondary cardiovascular disease prevention strategies as lipid modulating factors, there are limited data concerning the precise benefit of such therapy in patients with RA. Systemic inflammation and anti-inflammatory treatments influence lipid metabolism, leading to variable states of dyslipidemia in RA. Hence, the indications for statin therapy for cardiovascular prevention may differ between RA patients and the general population and the precise role of lipid lowering treatment in RA is yet to be established. Furthermore, some evidence supports a potential beneficial impact of statins on RA disease activity, attributable to their anti-inflammatory and immunomodulatory properties. This review discusses existing data on the efficacy of statins in reducing RA-related cardiovascular risk as well as their potential beneficial effects on disease activity.
Highlights
Rheumatoid arthritis (RA) imparts a significant risk for cardiovascular disease (CVD)-related morbidity and mortality [1, 2]
We reviewed the literature for cited articles relevant to the subject in articles identified through the review, to ensure that we did not miss important research data
Optimal cardiovascular risk management remains a challenging theme in RA
Summary
Rheumatoid arthritis (RA) imparts a significant risk for cardiovascular disease (CVD)-related morbidity and mortality [1, 2]. It is well-established that accelerated atherosclerosis and vascular dysfunction in the setting of RA are the result of a complex interplay between traditional CVD risk factors, such as dyslipidemia [3], insulin resistance [4], hypertension [5], limited physical activity [6], and obesity [7], and RA-related characteristics including chronic high grade inflammation and autoimmune activation [8, 9]. Assessment of CVD risk in patients with RA in routine clinical practice is highly recommended [10].
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