“Cardiovascular risk management is urgently needed for patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis,” commented Dr. Michael T. Nurmohamed, speaking on behalf of EULAR's cardiovascular disease risk management task force at the recent annual meeting of the American College of Rheumatology.

The EULAR task force recommendations that were specifically highlighted at the ACR meeting included:

▸ Characterization of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis as “high-risk” conditions with regard to cardiovascular disease, similar to the classification of diabetes.

▸ Launching annual screening for cardiovascular risk of every rheumatoid arthritis patient, with consideration of screening of ankylosing spondylitis and psoriatic arthritis patients as well.

▸ Providing every patient with lifestyle recommendations that are designed to lower their cardiovascular risk.

▸ Emphasizing aggressive control of disease activity to suppress inflammation and lower cardiovascular risk.

▸ Adapting cardiovascular risk scoring models (such as the newly adapted Systematic Coronary Risk Evaluation, or SCORE) by a factor of 1.5 to account for elevated baseline risk associated with inflammatory rheumatic diseases.

▸ Consideration of treatment with statins and/or antihypertensive medications according to cardiovascular management targets that are established by local guidelines; or, in case no local guidelines exist, when targets exceed the 10-year cardiovascular mortality risk models that were established in the recently adapted SCORE measure.

▸ Acknowledgment that the role of cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory drugs is so far not well established in rheumatoid arthritis patients.

▸ Limiting corticosteroids to the lowest possible doses.

The task force consisted of 21 rheumatologists, internists, cardiologists, and epidemiologists representing nine European countries.

The work of the task force was prompted by increasing recognition among the medical community that patients with rheumatoid arthritis face a steeply elevated risk in cardiovascular diseases, said Dr. Nurmohamed, who is a rheumatologist at the VU University Medical Center and Jan van Breemen Institute in Amsterdam.

The risk can only be partially explained by traditional risk factors, with inflammatory processes serving as the apparent “missing link,” he suggested.

Earlier this year, Dr. Nurmohamed and associates published the results of the CARRÉ study, in which they compared the cardiovascular risk in 353 patients with rheumatoid arthritis to two groups of similarly-aged patients enrolled in the population-based Hoorn cohort study.

There was a total of 194 patients who had type 2 diabetes and 258 healthy controls who were looked at in the study (Ann. Rheum. Dis. 2008 Aug. 12 [doi:10.1136/ard.2008.094151]).

The prevalence of cardiovascular disease was found to be 5% in nondiabetic patients with no rheumatoid arthritis; 12.4% in patients with type 2 diabetes, and 12.9% in patients with rheumatoid arthritis.

Some of that risk can be accounted for by increased hypertension, dyslipidemia, and lifestyle factors in the rheumatoid arthritis population, he said.

However, inflammatory rheumatic diseases in and of themselves also seem to confer an independent risk that should be accounted for in models that predict cardiovascular mortality, he urged.