Pharmacological management of cardiovascular risk in chronic inflammatory rheumatic diseases

ABSTRACT

Introduction

Cardiovascular comorbidity is a major burden in patients with chronic inflammatory rheumatic diseases and a significant determinant of their outcome. In addition to optimal management of the underlying inflammatory condition according to current guidelines, individual cardiovascular risk factors, particularly dyslipidaemia, hypertension, and impaired glucose tolerance should be assessed regularly and guide risk stratification and requirement for treatment.

Areas discussed

We critically reviewed manuscripts and guidelines on the pharmacological management of dyslipidaemia, hypertension, and diabetes in patients with chronic inflammatory rheumatic diseases (PubMed, MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar, up to 1 March 2020). Lifestyle changes are of paramount importance for the management of these risk factors. In the current narrative review, we discuss pharmacological therapies available and emerging therapies aiming to help patients achieve recommended targets, depending on their individual risk.

Expert opinion

CVD risk is increased in people with chronic inflammatory rheumatic diseases. Cardiovascular risk factor management is an essential part of their care. Although relevant guidance exists, there are still major gaps in knowledge and risk factor management implementation in these patient groups. Some practical guidance based on our interpretation of existing data and experience in the field is provided in this review.

KEYWORDS:

• Pharmacological
• cardiovascular
• risk
• inflammatory joint disease
• rheumatoid arthritis
• diabetes
• hypertension
• dyslipidaemia

Article highlights

• Cardiovascular morbidity and mortality is high in patients with chronic inflammatory rheumatic disorders and this is the result of high prevalence of traditional risk factors, high inflammatory burden, and their synergistic function

• When calculating the cardiovascular risk for patients with chronic inflammatory rheumatic disorders a multiplication factor of 1.5 is a useful risk stratification aid

• When pharmacotherapy is needed for hypertension combination therapy with renin-angiotensin aldosterone system (RAAS) blocker with a CCB (dihydropyridine) or a thiazide diuretic is preferred

• Limited data exist on the role of specific new lipid-lowering and diabetic agents in patients with chronic inflammatory rheumatic diseases and a generic, guideline-based approach should be adopted

Declaration of interest

GDK has received honoraria for lectures or consultancy fees or unrestricted grant support or hospitality for congress attendance Pfizer, Abbvie, UCB, BMS, Novartis, MSD, Roche, Astra Zeneca, GSK, Lilly. He is Chief Investigator of THE TRACE-RA trial for which Pfizer provided free atorvastatin and matching placebo and an unrestricted grant for the generation of a trial biobank. VP has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.