In a Current Opinion review Dr Nicola Goodson and Dr Daniel Solomon discuss the cardiovascular manifestations of some of the more common rheumatic conditions including: rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, systemic sclerosis, giant cell arteritis, and osteoarthritis.
The authors highlight recent studies examining cardiovascular disease (CVD) in patients with rheumatic conditions and identify several common themes, such as CVD presenting atypically in patients with inflammatory rheumatic disease with much of the excess mortality due to accelerated atherosclorosis. "It is difficult to separate out the effects of traditional cardiovascular risk factors from the effects of chronic inflammatory disease and its treatment when exploring CVD epidemiology in these patients," the authors explain.
Goodson and Solomon call for further investigation to determine the optimal prevention or treatment strategy and suggest the following approaches in the interim:
i) the aggressive management of CVD risk factors (hypertension, hyperlipidemia, and tobacco use) in all patients with rheumatic disease;
ii) the use of statins as a immunomodulator and lipid-lowering agents for hyperlipidemia among patients with rheumatic disease;
iii) using aspirin as a cardioprotective agent, where the cardiovascular benefits outweigh the gastrointestinal risks, and
iv) treatment of the underlying inflammatory condition to reduce the burden of CVD.
In summarising, the authors re-emphasise the association between cardiovascular morbidity/mortality and the rheumatic diseases, in particular the link between coronary heart disease and inflammatory rheumatic conditions.
They add, "Whilst it is likely that chronic systemic inflammation promotes accelerated atherosclerosis in these patients, the mechanisms by which this occurs are complex and the effects of treatment and other cardiovascular risk factors need to be considered."
Reference
Goodson, N. Solomon, D. et al. 2006, 'The cardiovascular manifestations of rheumatic diseases', Current Opinion in Rheumatology, vol. 18, pp. 135-140.
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