Management of cardiovascular disease risk in rheumatoid arthritis

Objective: To review the management of traditional and nontraditional CVD cardiovascular disease risk factors in rheumatoid arthritis (RA). Methods: Literature review of the management of CVD risk in RA. Results: Because of the increased risk of CVD events and CVD mortality among RA patients, aggressive management of CVD risk is essential. Providers should follow national guidelines for the management of traditional CVD risk factors, including dyslipidemia, hypertension, and diabetes mellitus. Similar efforts are needed in counseling on lifestyle modifications, including smoking cessation, regular exercise, and maintaining a healthy body weight. Because higher RA disease activity is also linked with CVD risk, aggressive treatment of RA to a target of low disease activity or remission is critical. Furthermore, the selection of potentially “cardioprotective” agents such as methotrexate and tumor necrosis factor inhibitors, while limiting use of nonsteroidal anti-inflammatory drugs and glucocorticoids, are strategies that could be employed by rheumatologists to help mitigate CVD risk in their patients with RA. Conclusion: Routine assessment of CVD risk, management of traditional CVD risk factors, counseling on healthy lifestyle habits, and aggressive treatment of RA are essential to minimize CVD risk in this population.