a Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds, Chapel Allerton Hospital , Leeds , UK.
b NIHR Leeds Biomedical Research Centre , Leeds Teaching Hospitals NHS Trust , Leeds , LS7 4SA , UK.
Expert Opin Drug Saf. 2018 Jul;17(7):697-708. doi: 10.1080/14740338.2018.1483331. Epub 2018 Jun 11.
Rheumatoid arthritis (RA) is associated with a heightened risk of cardiovascular disease (CVD), with both traditional CV risk factors and inflammation contributing to this risk.
This review highlights the burden of CVD in RA and associated traditional CV risk factors, including the complexity of dyslipidemia in RA and the so-called 'lipid paradox.' Furthermore, the recognized RA-disease-specific factors associated with higher risk of CVD and the role of systemic inflammation in the pathogenesis of CVD in RA will be addressed. With the advent of biologic and targeted synthetic therapies in the treatment of RA, the effect of conventional and newer generation disease modifying anti-rheumatic therapies (DMARDs) on CV risk and associated risk factors will also be discussed.
Identifying the RA phenotype at greatest risk of CVD, understanding the interplay of increased traditional risk factors, common inflammatory processes and RA-specific factors, and personalized use of DMARDs according to disease phenotype and comorbidity to reduce this risk are key areas for future research.
类风湿关节炎（RA）与心血管疾病（CVD）风险增加相关，传统心血管危险因素和炎症均促成了这种风险。
本文重点阐述了 RA 患者 CVD 的负担以及相关传统心血管危险因素，包括 RA 患者血脂异常的复杂性和所谓的“血脂悖论”。此外，还将讨论公认的与 CVD 风险增加相关的 RA 疾病特异性因素以及系统性炎症在 RA 患者 CVD 发病机制中的作用。随着生物制剂和靶向合成疗法在 RA 治疗中的应用，常规和新一代的疾病修正抗风湿疗法（DMARDs）对 CV 风险及相关危险因素的影响也将进行讨论。
确定 CVD 风险最高的 RA 表型，了解增加的传统危险因素、常见炎症过程和 RA 特异性因素之间的相互作用，以及根据疾病表型和合并症个体化使用 DMARDs 以降低这种风险是未来研究的重点领域。
