Rheumatoid arthritis and cardiovascular disease: an update on treatment issues.

Overview

PURPOSE OF REVIEW: This review examines thresholds for treatment of traditional cardiovascular disease (CVD) risk factors among patients with rheumatoid arthritis (RA) and whether RA-specific treatment modulates cardiovascular risk. RECENT FINDINGS: There are substantial data demonstrating an increased CVD risk among patients with RA. Both traditional CVD risk factors and inflammation contribute to this risk. Recent epidemiologic studies strengthen the case that aggressive immunosuppression with biologic disease-modifying anti-rheumatic drugs (DMARDs), such as tumour necrosis factor (TNF) antagonists, is associated with a reduced risk of CVD events. However, to date, there are no randomized controlled trials published regarding the management of CVD in RA. SUMMARY: Epidemiologic evidence continues to accumulate regarding the relationship between the effects of traditional CVD risk factors and RA-specific treatments on cardiovascular outcomes in RA. The field needs randomized controlled trials to better guide management.