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Rheumatology (Oxford). 2014 Dec;53(12):2143-54. doi: 10.1093/rheumatology/keu224. Epub 2014 Jun 6.

Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment.

Author information

1
Section of Rheumatology, Cardiff University School of Medicine, Cardiff, UK, Global Medical Affairs, F. Hoffmann-La Roche, Basel, Switzerland, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary and Departments of Internal Medicine and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
2
Section of Rheumatology, Cardiff University School of Medicine, Cardiff, UK, Global Medical Affairs, F. Hoffmann-La Roche, Basel, Switzerland, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary and Departments of Internal Medicine and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. choyeh@cardiff.ac.uk.

Abstract

Risk of cardiovascular (CV) disease is increased among RA patients. High inflammatory burden associated with RA appears to be a key driver of the increased cardiovascular risk. Inflammation is linked with accelerated atherosclerosis and associated with a paradoxical inversion of the relationship between CV risk and lipid levels in patients with untreated RA, recently coined the lipid paradox. Furthermore, the inflammatory burden is also associated with qualitative as well as quantitative changes in lipoproteins, with the anti-inflammatory and atheroprotective roles associated with high-density lipoprotein cholesterol significantly altered. RA therapies can increase lipid levels, which may reflect the normalization of lipids due to their inflammatory-dampening effects. However, these confounding influences of inflammation and RA therapies on lipid profiles pose challenges for assessing CV risk in RA patients and interpretation of traditional CV risk scores. In this review we examine the relationship between the increased inflammatory burden in RA and CV risk, exploring how inflammation influences lipid profiles, the impact of RA therapies and strategies for identifying and monitoring CV risk in RA patients aimed at improving CV outcomes.

KEYWORDS:

anti-rheumatic agents; atherosclerosis; cardiovascular disease; dyslipidaemias; inflammation; rheumatoid arthritis

PMID:
24907149
PMCID:
PMC4241890
DOI:
10.1093/rheumatology/keu224
[Indexed for MEDLINE]
Free PMC Article

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