Senior Research Fellow in Cardiology & Cardiac Electrophysiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, London, UK.
Research Practitioner, Royal Free London NHS Trust, Barnet Hospital, Wellhouse Lane, Wellhouse Lane, UK.
Expert Opin Pharmacother. 2022 Jun;23(8):947-958. doi: 10.1080/14656566.2022.2076594.
Rheumatoid Arthritis (RA) is a chronic inflammatory disorder associated with an increased incidence and prevalence of cardiovascular disease (CVD), including myocardial infarction and heart failure. In addition to traditional risk factors, evidence suggests inflammation is critical to the pathophysiology of both conditions. Despite the association being well-recognised, challenges remain in managing cardiovascular risk in RA.
This manuscript analyses the association between CVD and RA and explores the limitations in evaluating cardiovascular risk in RA with available risk assessment tools. The authors review the optimal management of traditional risk factors such as hypertension and dyslipidaemia and contemporary risk factors such as inflammation and analyse the cardiovascular impact of RA medications.
Analysis points to the critical role of inflammation in the pathogenesis of RA and CVD. It is well established that conventional disease-modifying anti-rheumatic drugs (DMARDs) improve cardiovascular outcomes; however, underlying risk often remains underappreciated. The authors suggest there remains an opportunity to improve mortality and morbidity with the early recognition and of at-risk populations and the timely initiation of appropriate cardiovascular and anti-inflammatory medications. More research is necessary into the role that imaging may play in stratifying risk and in the longer-term cardiovascular impact of biological DMARDs.
类风湿关节炎（RA）是一种慢性炎症性疾病，与心血管疾病（CVD）的发病率和患病率增加有关，包括心肌梗死和心力衰竭。除了传统的危险因素外，有证据表明炎症对这两种疾病的病理生理学都至关重要。尽管这种关联已得到广泛认可，但在 RA 中管理心血管风险仍存在挑战。
本文分析了 CVD 与 RA 之间的关联，并探讨了现有风险评估工具在评估 RA 心血管风险方面的局限性。作者回顾了高血压和血脂异常等传统危险因素以及炎症等当代危险因素的最佳管理，并分析了 RA 药物对心血管的影响。
分析指出炎症在 RA 和 CVD 发病机制中的关键作用。已证实常规的疾病修饰抗风湿药物（DMARDs）可改善心血管结局；然而，潜在风险往往仍未得到充分重视。作者认为，通过早期识别高危人群并及时开始使用适当的心血管和抗炎药物，仍然有机会改善死亡率和发病率。有必要进一步研究影像学在分层风险以及生物 DMARDs 的长期心血管影响方面可能发挥的作用。
