Management of Cardiovascular Disease Risk in Rheumatoid Arthritis

Conclusion

To mitigate the increased risk of CVD in RA, primary care and subspecialty providers alike must be aware of this heightened risk in RA, perform frequent assessments of CVD risk,³ and aggressively manage both traditional and nontraditional CVD risk factors. The differential roles in this effort may not be clear; thus, we have proposed a co-management strategy detailed in the Figure. Clear communication between providers is of the utmost importance to ensure effective management of CVD risk.

Given limited evidence for RA-specific CVD risk assessments and traditional risk factor treatment targets, management should follow pertinent national guidelines. The importance of lifestyle counseling should not be overlooked, with a focus on smoking cessation, healthy diet and body weight, and regular aerobic exercise. Finally, rheumatologists should aggressively manage RA using a treat-to-target approach, minimize the use of glucocorticoids and NSAIDs, and preferentially select DMARDs that have been associated with lower CVD risk. Through this comprehensive approach, recent trends of improved CVD outcomes in RA will hopefully become more widespread.¹⁰⁸

Corresponding author: Bryant R. England, MD; 986270 Nebraska Medical Center, Omaha, NE 68198-6270; Bryant.england@unmc.edu.

Financial disclosures: Dr. England is supported by UNMC Internal Medicine Scientist Development Award, UNMC Physician-Scientist Training Program, the UNMC Mentored Scholars Program, and the Rheumatology Research Foundation Scientist Development Award. Dr. Mikuls is supported by a VA Merit Award (CX000896) and grants from the National Institutes of Health: National Institute of General Medical Sciences (U54GM115458), National Institute on Alcohol Abuse and Alcoholism (R25AA020818), and National Institute of Arthritis and Musculoskeletal and Skin Diseases (2P50AR60772).