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  • Review Article
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Targeting cardiovascular risk in rheumatoid arthritis: a dual role for statins

Nature Reviews Rheumatology volume 6, pages 157–164 (2010)Cite this article

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Abstract

Rheumatoid arthritis (RA) is a prototypical immune-mediated inflammatory disease that is characterized by increased cardiovascular morbidity and mortality, independent of the traditional risk factors for cardiovascular disease. The chronic inflammatory state—a hallmark of RA—is considered to be a driving force for accelerated atherogenesis. Consequently, aggressive control of RA disease activity is thought to be instrumental for cardiovascular risk reduction. Currently, statin-mediated reduction of LDL-cholesterol levels is considered to be the cornerstone of cardiovascular disease prevention. In addition to their lipid-lowering capabilities, statins exert immunomodulatory effects, which could be of dual benefit in the treatment of RA. Guidelines on the reduction of cardiovascular risk in patients with RA are lacking, however, largely owing to the absence of data from randomized controlled trials. This Review focuses on the pathophysiology of cardiovascular events in RA, as well as the need to adjust cardiovascular risk engines to better-accommodate the impact of chronic inflammatory disease over and above the established risk factors to predict cardiovascular risk in patients with RA.

Key Points

  • Rheumatoid arthritis (RA) is an independent risk factor for cardiovascular events, with an impact over and above established risk factors for cardiovascular disease

  • Proper management of cardiovascular risk primarily requires aggressive control of RA disease activity

  • Statins are the cornerstone of cardiovascular risk management, offering both lipid-lowering efficacy and anti-inflammatory effects

  • Routine initiation of statins in patients with RA is not recommended until the results of large randomized, controlled trials become available

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Figure 1: Anti-inflammatory actions of statins in rheumatoid arthritis.

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Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105, AZ, The Netherlands

    Radjesh J. Bisoendial & Paul Peter Tak

  2. Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105, AZ, The Netherlands

    Erik S. G. Stroes & John J. P. Kastelein

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Bisoendial, R., Stroes, E., Kastelein, J. et al. Targeting cardiovascular risk in rheumatoid arthritis: a dual role for statins. Nat Rev Rheumatol 6, 157–164 (2010). https://doi.org/10.1038/nrrheum.2009.277

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