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Nat Rev Rheumatol. 2015 Dec;11(12):693-704. doi: 10.1038/nrrheum.2015.112. Epub 2015 Aug 18.

Cardiovascular comorbidity in rheumatic diseases.

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Amsterdam Rheumatology and Immunology Center, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, Netherlands.
Amsterdam Rheumatology and Immunology Center, Reade, PO Box 58271, 1040 HG Amsterdam, Netherlands.
Department of Rheumatology and Research &Development Directorate, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Clinical Research Unit, Dudley DY1 2HQ, UK.


Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity.

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