scholarly journals EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update

2016 ◽  
Vol 76 (1) ◽  
pp. 17-28 ◽  
Author(s):  
R Agca ◽  
S C Heslinga ◽  
S Rollefstad ◽  
M Heslinga ◽  
I B McInnes ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Risk Management ◽  
Expert Opinion ◽  
Disease Risk ◽  
Scientific Evidence ◽  
Cardiovascular Disease Risk ◽  
Evidence Base ◽  
Steering Committee ◽  
Cvd Risk

Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

scholarly journals Association of Apolipoprotein E Polymorphism with Adipokines and Cardiovascular Disease Risk in Rheumatoid Arthritis Patients

Life ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 330
Author(s):  
Yi-Ming Chen ◽  
Po-Ku Chen ◽  
Ching-Kun Chang ◽  
Chi-Chen Lin ◽  
Hsin-Hua Chen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Apolipoprotein E ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Density Lipoprotein ◽  
Atherogenic Index ◽  
Cvd Risk ◽  
Tnf Α ◽  
Apoe Genotypes

Apolipoprotein E (ApoE) polymorphism and adipokines are linked to atherosclerosis. We aimed to investigate the associations of apoE genotypes with adipokines, inflammatory parameters, and cardiovascular disease (CVD) risks in rheumatoid arthritis (RA) patients. We enrolled 152 RA patients and 49 healthy control (HC) subjects. The apoE genotyping was determined by a polymerase chain reaction, while plasma levels of adipokines and inflammatory cytokines were measured with ELISA. Although apoE genotypes distributions were indistinguishable between RA patients and HC, we found significantly higher levels of apoE and adipokines in RA patients compared with HC. RA patients with ε2ε3 genotype had lower levels of TNF-α, IL-6, resistin, and visfatin, but higher leptin levels compared with ε3ε3 genotype patients. Patients with ε3ε4 genotype had significantly higher low-density lipoprotein-cholesterol (LDL-C) levels and atherogenic index scores compared with ε2ε3 genotype carriers. Moreover, patients with ε2ε3 genotype had significantly lower 10-year CVD risk than ε3ε3 or ε3ε4 genotype patients. ε3ε4 genotype and adiponectin levels were independent predictors of a high 10-year CVD risk. RA patients with ε2ε3 genotype are associated with lower levels of TNF-α, IL-6, resistin, visfatin, and CVD risk, while RA patients with ε3ε4 genotype exhibited higher levels of LDL-C, insulin resistance, and higher CVD risks.

scholarly journals 200. CARDIOVASCULAR DISEASE RISK MANAGEMENT IN RHEUMATOID ARTHRITIS PATIENTS: A MULTI-CENTRE AUDIT IN THE MID-WEST REGION OF IRELAND

Rheumatology ◽  
2017 ◽  
Vol 56 (suppl_2) ◽  
Author(s):  
Maria Usman Khan ◽  
Usman Azhar Khan ◽  
Fahd Adeeb ◽  
Alwin Sebastian ◽  
Joe Devlin ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Risk Management ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
West Region

scholarly journals Assessment of Cardiovascular Disease Risk and Therapeutic Patterns among Urban Black Rheumatoid Arthritis Patients

2019 ◽  
Vol 7 (2) ◽  
pp. 31 ◽  
Author(s):  
Isabel M. McFarlane ◽  
Su Yien Zhaz Leon ◽  
Manjeet S. Bhamra ◽  
Aaliya Burza ◽  
Stephen Anthony Waite ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Black Population ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Predominantly Black ◽  
Effective Interventions

Rheumatoid arthritis (RA) patients have nearly twice the risk of cardiovascular disease (CVD) compared to the general population. We aimed to assess, in a predominantly Black population, the prevalence of traditional and RA-specific CVD risk factors and therapeutic patterns. Utilizing ICD codes, we identified 503 RA patients ≥18 years old who were seen from 2010 to 2017. Of them, 88.5% were Black, 87.9% were women and 29.4% were smokers. CVD risk factors (obesity, diabetes, hypertension, dyslipidemia) were higher than in previously reported White RA cohorts. Eighty-seven percent of the patients had at least one traditional CVD risk factor, 37% had three or more traditional CVD risk factors and 58% had RA-specific risk factors (seropositive RA, >10 years of disease, joint erosions, elevated inflammatory markers, extra-articular disease, body mass index (BMI) < 20). CV outcomes (coronary artery disease/myocardial infarction, heart failure, atrial fibrillation and stroke) were comparable to published reports. Higher steroid use, which increases CVD risk, and lesser utilization of biologics (decrease CV risk) were also observed. Our Black RA cohort had higher rates of traditional CVD risk factors, in addition to chronic inflammation from aggressive RA, which places our patients at a higher risk for CVD outcomes, calling for revised risk stratification strategies and effective interventions to address comorbidities in this vulnerable population.

scholarly journals Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Ahmed Solomon ◽  
Linda Tsang ◽  
Angela J. Woodiwiss ◽  
Aletta M. E. Millen ◽  
Gavin R. Norton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Stratification ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cvd Risk ◽  
Black Patients ◽  
African Black ◽  
Reported Data

Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further, reported data on CVD and its risk factors derive mostly from data obtained in the developed world. An earlier epidemiological health transition is intrinsic to persons living in rural areas and those undergoing urbanization. It is therefore conceivable that optimal CVD risk stratification differs amongst patients with RA from developing populations compared to those from developed populations. Herein, we briefly describe current CVD and its risk factor profiles in the African black population at large. Against this background, we review reported data on CVD risk and its potential stratification amongst African black compared to white patients with RA. Routinely assessed traditional and nontraditional CVD risk factors were consistently and independently related to atherosclerosis in African white but not black patients with RA. Circulating concentrations of novel CVD risk biomarkers including interleukin-6 and interleukin-5 adipokines were mostly similarly associated with both endothelial activation and atherosclerosis amongst African black and white RA patients.

Benefits of Methotrexate Use on Cardiovascular Disease Risk among Rheumatoid Arthritis Patients Initiating Biologic Disease-Modifying Antirheumatic Drugs

2020 ◽  
pp. jrheum.191326
Author(s):  
Fenglong Xie ◽  
Lang Chen ◽  
Huifeng Yun ◽  
Emily B. Levitan ◽  
Jeffrey R. Curtis
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Primary Outcome ◽  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Cvd Risk ◽  
Disease Modifying

Objective Methotrexate has been associated with reduced risk for cardiovascular disease (CVD) events among rheumatoid arthritis (RA) patients not exposed to biologic disease-modifying antirheumatic drugs (bDMARD). The effect of concomitant methotrexate on CVD risk among RA patients initiating bDMARDs remains unknown. Methods A retrospective cohort study was conducted to assess the effect of methotrexate on CVD risk using 2006–2015 Medicare claims data for RA patients initiating bDMARDS. The main exposure was current use of methotrexate, updated in a time varying fashion. The primary outcome was a composite of incident myocardial infarction, stroke, and fatal CVD. Secondary outcomes were each event that comprised the primary outcome. Incidence rates (IR) and 95% confidence intervals (CI) were calculated using Poisson regression. Associations between methotrexate and risk of CVD were assessed using Cox regression. Results A total of 88,255 bDMARD initiations and 1,861 CVD events were included in this study. Mean age was 64.6 (12.3) years, 84.0% female, 68.2% non-Hispanic white. The crude IRs for CVD were 17.9 (16.9–18.8) and 12.1 (95%CI: 11.1–13.2) per 1,000 patient-years among methotrexate unexposed and exposed, respectively. The multivariable adjusted HR for CVD events associated with methotrexate was 0.76 (0.68– 0.85). Multivariable adjusted HRs were 0.78 (0.66, 0.91), 0.74 (0.62, 0.88), 0.77 (0.68, 0.86), and 0.82 (0.73, 0.93) for MI, stroke, MI or stroke, and a composite CVD outcome. Results were robust in sensitivity and subgroup analyses. Conclusion Among RA patients receiving biologics, concomitant methotrexate use was associated with a 24% lower risk for CVD events.

scholarly journals SAT0641-HPR FACTORS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN KOREAN ADULTS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1280.3-1280
Author(s):  
S. Y. Shin ◽  
J. H. Lee ◽  
B. Y. Youn
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Family Income ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cognitively Impaired ◽  
Cvd Risk

Background:For persons with chronic diseases including rheumatoid arthritis (RA), undamaged cognitive capacity is critical for daily functioning, treatment compliance, and self-management. Disease-specific features of RA such as systemic chronic inflammation or increased comorbid cardiovascular disease (CVD) risk may be closely linked to neurocognitive dysfunction in RA patients [1]. However, the evidence of brain involvement in RA is very rare or even controversial and very little is known about the pathogenic mechanisms of cognitive decline in persons with RA.Objectives:This study explored the prevalence of cognitive impairment in Korean adults with RA using a set of computerized neurocognitive tests and the factors that were significantly associated with cognitive impairment.Methods:Individuals with RA were recruited by their rheumatologists during follow-up visits at one university hospital in Korea. After getting signed consents, a trained research nurse assessed participants with a range of physical, psychosocial, and biological metrics. Cognitive function was assessed using a set of 6 computerized neurocognitive tests yielding 18 indices covering a range of cognitive domains. Subjects were classified as ‘impaired’ if they performed 1SDbelow age-based population norms on each test [2]. The total cognitive function score was calculated by summing the transformed scores, ranging from 0 (no impairment) to 18 (worst impairment). Multiple linear regression analyses were conducted to identify the significant factors influencing cognitive impairment.Results:Sixty five subjects with a mean (±SD) age of 61.9 (±10.0) years were included. 85% were female, 89% were married, and 76% had less 12 years of education. Mean disease activity score (DAS-28) was 2.3 (±1.3) and mean disease duration was 9.8 (±8.7) years. Mean functional limitations score (HAQ) was 0.3 (±0.5) and mean CVD risk factors were 2.3 (±1.5). Total cognitive function score was 11.1 ± 4.0 (2-18). The proportion of persons who were classified as cognitively impaired on each test ranged from 25% to 92%. The proportion of persons classified as cognitively impaired on the quarter of total subtests (5 or more out of 18 subtests) was 94%. The multivariate regression model was statistically significant and accounted for 39% of the variance in cognitive impairment (F=5.26,p<.001). Education (β=-0.32,p=0.010), family income (β=-0.26,p=0.040), and cardiovascular disease risk factors (β=0.27,p=0.025) were significantly associated with cognitive impairment controlling for other covariates.Conclusion:A significant number of RA patients were cognitively impaired. Less education, less family income, and increased cardiovascular disease risk factors were the significant factors affecting cognitive impairment in RA. The findings of this study suggest that the burden of cognitive impairment in RA patients is significant, and future studies identifying specific etiological contributors to cognitive impairment are warranted.References:[1]Wallin, K., Solomon, A., Kåreholt, I., Tuomilehto, J., Soininen, H., & Kivipelto, M. (2012). Midlife rheumatoid arthritis increases the risk of cognitive impairment two decades later: a population-based study.Journal of Alzheimer’s Disease, 31(3), 669-676.[2]Kozora, E., Ellison, M. C., & West, S. (2004). Reliability and validity of the proposed American College of Rheumatology neuropsychological battery for systemic lupus erythematosus.Arthritis Care & Research, 51(5), 810-818.Acknowledgments:This research was supported by the 2018 Inje University research grant (No.20180148).Disclosure of Interests:None declared

scholarly journals Hot Flashes and Cardiovascular Disease Risk Indices Among Women With HIV

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Mabel Toribio ◽  
Evelynne S Fulda ◽  
Sarah M Chu ◽  
Zsofia D Drobni ◽  
Magid Awadalla ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
General Population ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Hot Flashes ◽  
Cvd Risk ◽  
Hot Flash ◽  
Risk Indices ◽  
Women With Hiv

Abstract Women with HIV (WWH) transitioning through menopause have heightened cardiovascular disease (CVD) risk. In the general population, hot flash burden relates to CVD risk indices. We found higher hot flash burden among women with vs without HIV. Further, among WWH, hot flash burden related to select CVD risk indices. ClinicalTrials.gov Registration NCT02874703.

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