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  • Review Article
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Cardiovascular comorbidity in rheumatic diseases

Nature Reviews Rheumatology volume 11, pages 693–704 (2015)Cite this article

Subjects

Key Points

  • Patients with inflammatory joint diseases (IJDs) have an increased burden of cardiovascular disease compared with the general population

  • Inflammation and traditional risk factors contribute to the cardiovascular risk associated with IJDs

  • IJDs and atherosclerosis are thought to have a common, inflammatory pathogenesis

  • Cardiovascular risk management is unsatisfactory in patients with IJD

  • The main pillars of cardiovascular management in IJD are pharmacological and nonpharmacological approaches to reduce cardiovascular risk factors, along with tight control of disease activity

  • Coordination of care between rheumatologists, internists, cardiologists and primary-care physicians should be increased to optimize management of cardiovascular risk in patients with IJD

Abstract

Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity.

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Figure 1: Contributors to cardiovascular risk in IJDs.
Figure 2: Contribution of inflammation to cardiovascular disease.
Figure 3: Principles of cardiovascular risk management by rheumatologists.

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Authors and Affiliations

  1. Amsterdam Rheumatology and Immunology Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, Netherlands

    Michael T. Nurmohamed

  2. Amsterdam Rheumatology and Immunology Center, Reade, PO Box 58271, 1040 HG, Amsterdam, Netherlands

    Maaike Heslinga

  3. Department of Rheumatology and Research & Development Directorate, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Clinical Research Unit, DY1 2HQ, Dudley, UK

    George D. Kitas

Authors
  1. Michael T. Nurmohamed
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All authors contributed equally to discussion of content, writing the article and reviewing and editing the manuscript before submission.

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Correspondence to George D. Kitas.

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Competing interests

M.T.N. has received honoraria for lectures or advisory boards from Abbvie, BMS, Janssen, Merck, Pfizer and Roche, and unrestricted educational grants from Abbvie, BMS, Pfizer and Roche. G.D.K. has received honoraria for lectures or advisory boards, as well as hospitality, from Abbvie, BMS, Lilly, Novartis, Pfizer, Roche and UCB, and unrestricted educational grants from Pfizer. M.H. declares no competing interests.

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Nurmohamed, M., Heslinga, M. & Kitas, G. Cardiovascular comorbidity in rheumatic diseases. Nat Rev Rheumatol 11, 693–704 (2015). https://doi.org/10.1038/nrrheum.2015.112

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