Patients with a range of rheumatic diseases are at increased risk of cardiovascular disorders towards a re-evaluation of the European League against Rheumatism (EULAR)s recommendations for cardiovascular risk management?

The notion that patients with rheumatic disorders are at increased risk of developing cardiovascular diseases has been ongoing for many years and has sparked much debate concerning whether and when to initiate cardiovascular prevention therapies.

The initiation of preventive therapies, such as blood pressure lowering drugs or statins, is usually recommended in patients at high risk of developing adverse cardiovascular outcomes. Accurately assessing an individual’s cardiovascular risk is hence important. Until now, the modest size and duration of follow-up of available cohorts have been a barrier to precise quantification of cardiovascular risk in specific rheumatic disorders.1 In particular, there is a lack of robust evidence about the rates of cardiovascular morbidity and mortality among people with diseases such as vasculitis, systemic sclerosis, or Sjögren’s syndrome, and emerging evidence for excess risk in patients with systemic lupus erythematosus has not been validated in external cohorts.2 The best evidence is available for rheumatoid arthritis, which has been shown to increase cardiovascular risk by approximately 50% beyond that explained by established risk factors.3 As a result, the current cardiovascular disease prevention guidelines from the European Society of Cardiology (2021) recommend a lower threshold for the initiation of preventive therapies in adults with rheumatoid arthritis, by multiplying patients’ calculated risk score by 1.5, but make no mention of risk multipliers for other rheumatic diseases.4 The recent update of the European Alliance of Associations for Rheumatology (EULAR)’s recommendations (2022) did not endorse the use of any specific cardiovascular risk assessment tool nor risk multipliers for conditions beyond rheumatoid arthritis—although a thorough assessment of cardiovascular risk is recommended.5

A recent large-scale epidemiological study brings new evidence to this important clinical challenge. Using electronic health record data from 22 million individuals in the UK,6 Conrad et al examined 19 autoimmune disorders, including …

留言 (0)

沒有登入
gif