Cardiovascular Risk Management in RA | Arthritis Information

The 10 recommendations, and their accompanying level of evidence rating and strength of recommendation, are as follows:

1. RA should be considered as a disease in which cardiovascular risk is elevated, because of both an increased prevalence of traditional cardiovascular risk factors and the inflammatory burden. Although the evidence base is less, this may also apply to ankylosing spondylitis and psoriatic arthritis (level of evidence and strength of recommendation, 2b-3 B).
2. To lower cardiovascular risk, adequate control of arthritis disease activity is necessary (level of evidence and strength of recommendation, 2b-3 B).
3. All patients with RA should undergo annual cardiovascular risk evaluation with use of national guidelines. This should also be considered for all patients with ankylosing spondylitis and psoriatic arthritis. When antirheumatic treatment has been changed, risk assessments should be repeated (level of evidence and strength of recommendation, 3-4 C).
4. For patients with RA, risk score models should be adapted by introducing a 1.5 multiplication factor when the patient meets 2 of the following 3 criteria: disease duration of more than 10 years, rheumatoid factor or anti-cyclic citrullinated peptide positivity, and the presence of certain extra-articular manifestations (level of evidence and strength of recommendation, 3-4 C).
5. When using the Systematic Coronary Risk Evaluation model for determination of cardiovascular risk, triglyceride/high-density lipoprotein cholesterol ratio should be used (level of evidence and strength of recommendation, 3 C).
6. Intervention for cardiovascular risk factor management should be performed according to national guidelines (level of evidence and strength of recommendation, 3 C).
7. Preferred treatment options are statins, angiotensin-converting enzyme inhibitors, and/or angiotensin-II blockers (level of evidence and strength of recommendation, 2a-3 C-D).
8. The effect of cyclooxygenase-2 inhibitors and most nonsteroidal anti-inflammatory drugs (NSAIDs) on cardiovascular risk is not completely determined and should be studied further. Clinicians should therefore be very cautious in prescribing these drugs, especially to patients with cardiovascular risk factors or with documented cardiovascular disease (level of evidence and strength of recommendation, 2a-3 C).
9. When corticosteroids are prescribed, this should be at the lowest possible dose (level of evidence and strength of recommendation, 3 C).
10. Patients should be actively encouraged to stop smoking (level of evidence and strength of recommendation, 3 C).

"Cardioprotective treatment should be initiated when the estimated 10 year CV risk is above the risk threshold for each country, whether 10 or 20%," the guidelines authors conclude. "Finally, the clear relationship between disease activity and CV disease underscores the important role of tight disease control."