Skip to main content
main-content
Top

18-08-2015 | Comorbidities | Article

Cardiovascular comorbidity in rheumatic diseases

Authors:
Michael T. Nurmohamed, Maaike Heslinga, George Kitas, Andrew J Murphy

Abstract

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.

Nat Rev Rheumatol 2015; 11: 693–704. doi:10.1038/nrrheum.2015.112

Compared with the general population, patients with rheumatic diseases are at increased risk of developing several comorbid conditions, of which cardiovascular comorbidities are the most common and have the greatest effect on mortality.1 The epidemiology and pathogenesis of cardiovascular comorbidities in inflammatory joint diseases (IJDs) are particularly well-studied for rheumatoid arthritis (RA), but have also been investigated for rheumatic diseases such as ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE). Growing awareness of this increased cardiovascular risk has led to several efforts to unravel the underlying mechanisms, especially in RA. The elevated risk is only partly explained by increased prevalence of traditional cardiovascular risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus; systemic inflammation, genetic factors and treatment effects might also have important roles (Figure 1). Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be a shared factor in all IJDs. However, not all cardiovascular comorbidity and mortality can be attributed to atherosclerosis: nonischaemic heart failure (HF), microvascular dysfunction, cardiac autonomic neuropathy and arrhythmias are emerging as major contributors to the cardiovascular burden, and medications to treat the rheumatic disease can influence cardiovascular risk positively or negatively. Some cardiac manifestations show a degree of disease specificity—conduction disturbances and aortic insufficiency, for example, are associated with AS.2

Please log in to get access to this content

Related topics