Cardiovascular Risk in Rheumatic Inflammatory Disease

Cardiovascular Risk in Rheumatic Inflammatory Disease Posted By:
...

It is well documented that those with rheumatic inflammatory diseases have an increased risk of cardiovascular disease (CVD). That risk may vary by individual depending on the specific disease and, often, on the severity of disease. For example, CVD prevalence is highest in those with systemic lupus erythematous versus other rheumatic inflammatory diseases; rheumatoid arthritis follows with the second highest CVD prevalence among the immune-mediated inflammatory conditions, with some studies showing as much as a 50% increase in CVD mortality rate in patients with rheumatoid arthritis versus the general population. Patients with psoriatic arthritis have also been found to have higher incidence rates of cardiovascular disorders including hypertension, hyperlipidemia, coronary artery disease, cerebrovascular disease, and peripheral vascular disease, as well as a higher rate of hospitalization due to CVD when compared with the general population. While the prevalence of CVD in patients with ankylosing spondylitis is unclear, CVD represents the leading cause of death in patients with ankylosing spondylitis—such patients also have an increased risk of myocardial infarction, stroke, venous thrombotic events, and heart failure compared with the general population.

Despite these known risks, patients with rheumatic inflammatory diseases are often not monitored or screened for cardiovascular risk factors. The question of who should be monitoring patients provides an ongoing debate. Should primary care providers be screening and monitoring these patients? Should rheumatology care providers be screening them? Primary care providers may be more inclined to screen for and treat various risk factors of CVD—such as hyperlipidemia, hypertension, and obesity—at routine appointments; however, rheumatology care providers may have more frequent visits with the patients due to treatment monitoring protocols for rheumatic diseases. In my opinion, both primary care and rheumatology care providers should monitor for CVD risk. One important role that rheumatology care providers specifically can play in reducing cardiovascular risk is providing optimal treatment of rheumatic inflammatory diseases to minimize overall CVD risk. Causes of higher CVD rates in rheumatology patients include systemic inflammation, endothelial dysfunction, and arterial stiffness; a plethora of research has shown that by reducing disease activity, CVD morbidity and mortality decreases in patients with these conditions.

Regardless of which care provider may be following patients with rheumatic inflammatory diseases, all patients should be getting periodic cardiac risk factor assessments, help with smoking cessation, and encouragement to eat a healthy diet and participate in regular exercise to keep as healthy as possible.

References
  • Aviña-Zubieta JA, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59:169.
  • Exarchou S, et al. Mortality in ankylosing spondylitis: results from a nationwide population-based study. Ann Rheum Dis. 2016;75:1466.
  • Fernández-Gutiérrez B, et al. Cardiovascular disease in immune-mediated inflammatory diseases: A cross-sectional analysis of 6 cohorts. Medicine (Baltimore). 2017;96:e7308.
  • Kaine J, et al. Higher incidence rates of comorbidities in patients with psoriatic arthritis compared with the general population using US administrative claims data. J Manag Care Spec Pharm. 2019;25:122.

Share

Filed under: Cardiometabolic , Rheumatology

Related
The Gift of Time and Key Connection Between Diabetes Mellitus and Autoimmune Disorders

The Gift of Time and Key Connection Between Diabet ...

Are you aware that approximately 64,000 Americans are diagnosed with type 1 diabetes (T1D) each year ...

Filed under: Cardiometabolic


Continue Reading
The Importance of Shared Decision-making in Obesity

The Importance of Shared Decision-making in Obesit ...

Many areas of healthcare are starting to talk about the importance of shared decision-making (SDM), ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading
Addressing ASCVD Risk in HIV: An Update to the DHHS HIV Guidelines

Addressing ASCVD Risk in HIV: An Update to the DHH ...

The incidence of atherosclerotic cardiovascular disease (ASCVD) is estimated to be twice as high in ...

Filed under: Infectious Diseases, Preventive Medicine, Public Health, Cardiometabolic, NPs & PAs


Continue Reading
Understanding the Multifactorial Etiology of Obesity and the Metabolic Adaptations to Weight Loss

Understanding the Multifactorial Etiology of Obesi ...

Obesity Causes Overeating, Not the Other Way AroundOne of my favorite quotes from Dr Lee Kaplan is, ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading
Atrial Fibrillation: Optimizing Outcomes by Addressing Social Determinants of Health and Implicit Bias

Atrial Fibrillation: Optimizing Outcomes by Addres ...

Atrial fibrillation (AF) is the most common sustained arrhythmia diagnosed, and its prevalence is ex ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading
My Experience With GLP-1 Receptor Agonists in Patients With Type 2 Diabetes

My Experience With GLP-1 Receptor Agonists in Pati ...

When considering the benefits of glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) for our pat ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading