RESEARCH - Vascular comorbidity in RA: potential mechanisms and solutions

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Curr Opin Rheumatol. 2005 May;17(3):286-92.

Vascular comorbidity in rheumatoid arthritis: potential mechanisms and

solutions.

Sattar N, McInnes IB.

aSection of Vascular Biochemistry, Division of Cardiovascular and Medical

Sciences, and bCentre for Rheumatic Diseases, University of Glasgow, Glasgow

Royal Infirmary, Scotland, UK.

PURPOSE OF REVIEW: To summarise recent evidence for elevated risk of

coronary heart disease (CHD) in rheumatoid arthritis (RA) and explore

explanatory mechanisms and modalities that may lessen such risk. RECENT

FINDINGS: Evidence for elevated CHD risk in RA is convincing. On current

estimates, individuals who have had RA for several years have around a

twofold higher risk for CHD compared with non-RA persons after taking

account of most traditional risk factors. Such excess risk appears to be

driven by systemic inflammation both directly via its deleterious effects on

blood vessels (endothelial dysfunction inclusive of myocardial microvascular

abnormalities) and indirectly by its accentuation of multiple risk pathways

including lipid abnormalities. Established therapies that lessen RA disease

activity and systemic inflammation will likely lessen CHD risk, although

there remains considerable scope for more robust studies employing better

measures of vascular disease (e.g., carotid intima-media thickening). Other

emerging evidence indicates statins may have dual effects in RA, with a

modest disease-modifying effect (requiring confirmation) and significant

lipid-lowering action. The latter finding is particularly important because

extrapolation of data from all statin endpoint trials suggests that the

extent of low-density lipoprotein cholesterol reduction may account for most

statin clinical benefit.

SUMMARY: Systemic inflammation is the major driver for excess vascular

comorbidity in RA. Controlling systemic inflammation should lessen vascular

risk but complete, long-term suppression of articular inflammation is rarely

achieved. Thus, the use of conventional CHD risk reduction strategies, in

particular statins, should be considered in patients with RA with prevalent

CHD or at elevated risk.

PMID: 15838238

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Mayo Clinic in Rochester

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s Hopkins Medicine

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