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  • Review Article
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Cardiorheumatology: cardiac involvement in systemic rheumatic disease

Nature Reviews Cardiology volume 12, pages 168–176 (2015)Cite this article

Subjects

Key Points

  • Patients with rheumatic diseases have a high prevalence of cardiovascular manifestations and are at considerable risk of developing atherosclerosis

  • Cardiovascular complications in patients with rheumatic diseases include vascular, valvular, myocardial, and pericardial disorders, as well as electrical abnormalities

  • Multiple mechanisms can link atherosclerosis to autoimmune rheumatic disease

  • Early diagnosis and appropriate preventive management are necessary to address the burden of cardiovascular disease among patients with inflammatory autoimmune diseases

Abstract

Autoimmune rheumatic diseases can affect the cardiac vasculature, valves, myocardium, pericardium, and conduction system, leading to a plethora of cardiovascular manifestations that can remain clinically silent or lead to substantial cardiovascular morbidity and mortality. Although the high risk of cardiovascular pathology in patients with autoimmune inflammatory rheumatological diseases is not owing to atherosclerosis alone, this particular condition contributes substantially to cardiovascular morbidity and mortality—the degree of coronary atherosclerosis observed in patients with rheumatic diseases can be as accelerated, diffuse, and extensive as in patients with diabetes mellitus. The high risk of atherosclerosis is not solely attributable to traditional cardiovascular risk factors: dysfunctional immune responses, a hallmark of patients with rheumatic disorders, are thought to cause chronic tissue-destructive inflammation. Prompt recognition of cardiovascular abnormalities is needed for timely and appropriate management, and aggressive control of traditional risk factors remains imperative in patients with rheumatic diseases. Moreover, therapies directed towards inflammatory process are crucial to reduce cardiovascular disease morbidity and mortality. In this Review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders, their underlying pathophysiology, and available management strategies, with particular emphasis on the vascular aspects of the emerging field of 'cardiorheumatology'.

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Figure 1: Multiple cardiovascular manifestations of rheumatic diseases.
Figure 2: Common mechanisms underlying atherosclerosis and rheumatoid arthritis.
Figure 3: Cumulative incidence of cardiovascular manifestations in patients with or without RA.
Figure 4: Cumulative incidence of congestive heart failure in patients with or without RA.

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References

  1. Kitas, G., Banks, M. J. & Bacon, P. A. Cardiac involvement in rheumatoid disease. Clin. Med. 1, 18–21 (2001).

    Article  CAS  Google Scholar 

  2. Ku, I. A., Imboden, J. B., Hsue, P. Y. & Ganz, P. Rheumatoid arthritis: model of systemic inflammation driving atherosclerosis. Circ. J. 73, 977–985 (2009).

    Article  CAS  PubMed  Google Scholar 

  3. Full, L. E., Ruisanchez, C. & Monaco, C. The inextricable link between atherosclerosis and prototypical inflammatory diseases rheumatoid arthritis and systemic lupus erythematosus. Arthritis Res. Ther. 11, 217 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bartoloni, E., Shoenfeld, Y. & Gerli, R. Inflammatory and autoimmune mechanisms in the induction of atherosclerotic damage in systemic rheumatic diseases: two faces of the same coin. Arthritis Care Res. (Hoboken) 63, 178–183 (2011).

    Article  CAS  Google Scholar 

  5. Libby, P., Okamoto, Y., Rocha, V. Z. & Folco, E. Inflammation in atherosclerosis: transition from theory to practice. Circ. J. 74, 213–220 (2010).

    Article  CAS  PubMed  Google Scholar 

  6. Tervaert, J. W. Translational mini-review series on immunology of vascular disease: accelerated atherosclerosis in vasculitis. Clin. Exp. Immunol. 156, 377–385 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Symmons, D. P. & Gabriel, S. E. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat. Rev. Rheumatol. 7, 399–408 (2011).

    Article  PubMed  Google Scholar 

  8. Montecucco, F. & Mach, F. Common inflammatory mediators orchestrate pathophysiological processes in rheumatoid arthritis and atherosclerosis. Rheumatology (Oxford) 48, 11–22 (2009).

    Article  CAS  Google Scholar 

  9. Montecucco, C. et al. Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin. Exp. Rheumatol. 17, 407–412 (1999).

    CAS  PubMed  Google Scholar 

  10. Breland, U. M. et al. Inflammatory markers in patients with coronary artery disease with and without inflammatory rheumatic disease. Rheumatology (Oxford) 49, 1118–1127 (2010).

    Article  CAS  Google Scholar 

  11. Wu, R. & Lefvert, A. K. Autoantibodies against oxidized low-density lipoproteins (oxLDL): characterization of antibody isotype, subclass, affinity and effect on the macrophage uptake of oxLDL. Clin. Exp. Immunol. 102, 174–180 (1995).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Lai, M. H. et al. Effect of abdominal acupuncture therapy on the endocrine and metabolism in obesity-type polycystic ovarian syndrome patients [Chinese]. Zhen Ci Yan Jiu 35, 298–302 (2010).

    PubMed  Google Scholar 

  13. Kotani, T. et al. Serum levels of matrix metalloproteinase (MMP) 9, a risk factor for acute coronary syndrome, are reduced independently of serum MMP-3 by anti-TNF-alpha antibody (infliximab) therapy in patients with rheumatoid arthritis. J. Pharmacol. Sci. 120, 50–53 (2012).

    Article  CAS  PubMed  Google Scholar 

  14. McInnes, I. B. et al. Effect of interleukin-6 receptor blockade on surrogates of vascular risk in rheumatoid arthritis: MEASURE, a randomised, placebo-controlled study. Ann. Rheum. Dis. http://dx.doi.org/10.1136/annrheumdis-2013-204345.

  15. van der Wal, A. C. et al. Recent activation of the plaque immune response in coronary lesions underlying acute coronary syndromes. Heart 80, 14–18 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Pasceri, V. & Yeh, E. T. A tale of two diseases: atherosclerosis and rheumatoid arthritis. Circulation 100, 2124–2126 (1999).

    Article  CAS  PubMed  Google Scholar 

  17. Liuzzo, G. et al. Perturbation of the T-cell repertoire in patients with unstable angina. Circulation 100, 2135–2139 (1999).

    Article  CAS  PubMed  Google Scholar 

  18. Roman, M. J. & Salmon, J. E. Cardiovascular manifestations of rheumatologic diseases. Circulation 116, 2346–2355 (2007).

    Article  PubMed  Google Scholar 

  19. Wolfe, F. et al. The mortality of rheumatoid arthritis. Arthritis Rheum. 37, 481–494 (1994).

    Article  CAS  PubMed  Google Scholar 

  20. Wallberg-Jonsson, S., Ohman, M. L. & Dahlqvist, S. R. Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J. Rheumatol. 24, 445–451 (1997).

    CAS  PubMed  Google Scholar 

  21. Solomon, D. H. et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 107, 1303–1307 (2003).

    Article  PubMed  Google Scholar 

  22. Fischer, L. M., Schlienger, R. G., Matter, C., Jick, H. & Meier, C. R. Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. Am. J. Cardiol. 93, 198–200 (2004).

    Article  PubMed  Google Scholar 

  23. Turesson, C., Jarenros, A. & Jacobsson, L. Increased incidence of cardiovascular disease in patients with rheumatoid arthritis: results from a community based study. Ann. Rheum. Dis. 63, 952–955 (2004).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Peters, M. J. et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann. Rheum. Dis. 69, 325–331 (2010).

    Article  CAS  PubMed  Google Scholar 

  25. Hollan, I. et al. Cardiovascular disease in autoimmune rheumatic diseases. Autoimmun. Rev. 12, 1004–1015 (2013).

    Article  CAS  PubMed  Google Scholar 

  26. Van Doornum, S., McColl, G. & Wicks, I. P. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum. 46, 862–873 (2002).

    Article  CAS  PubMed  Google Scholar 

  27. Shoenfeld, Y. et al. Accelerated atherosclerosis in autoimmune rheumatic diseases. Circulation 112, 3337–3347 (2005).

    Article  PubMed  Google Scholar 

  28. Michaud, K., Vera-Llonch, M. & Oster, G. Mortality risk by functional status and health-related quality of life in patients with rheumatoid arthritis. J. Rheumatol. 39, 54–59 (2012).

    Article  PubMed  Google Scholar 

  29. Sodergren, A., Stegmayr, B., Lundberg, V., Ohman, M. L. & Wallberg-Jonsson, S. Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis. Ann. Rheum. Dis. 66, 263–266 (2007).

    Article  PubMed  Google Scholar 

  30. Crowson, C. S., Matteson, E. L., Roger, V. L., Therneau, T. M. & Gabriel, S. E. Usefulness of risk scores to estimate the risk of cardiovascular disease in patients with rheumatoid arthritis. Am. J. Cardiol. 110, 420–424 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  31. del Rincon, I. D., Williams, K., Stern, M. P., Freeman, G. L. & Escalante, A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum. 44, 2737–2745 (2001).

    Article  CAS  PubMed  Google Scholar 

  32. Mosca, L. et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. Circulation 123, 1243–1262 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Maradit-Kremers, H. et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 52, 402–411 (2005).

    Article  PubMed  Google Scholar 

  34. Peters, M. J. et al. Does rheumatoid arthritis equal diabetes mellitus as an independent risk factor for cardiovascular disease? A prospective study. Arthritis Rheum. 61, 1571–1579 (2009).

    Article  PubMed  Google Scholar 

  35. Cervera, R. et al. Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 78, 167–175 (1999).

    Article  CAS  Google Scholar 

  36. Esdaile, J. M. et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 44, 2331–2337 (2001).

    Article  CAS  PubMed  Google Scholar 

  37. Roman, M. J. et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N. Engl. J. Med. 349, 2399–2406 (2003).

    Article  CAS  PubMed  Google Scholar 

  38. Villa-Forte, A. & Mandell, B. F. Cardiovascular disorders and rheumatic disease [Spanish]. Rev. Esp. Cardiol. 64, 809–817 (2011).

    Article  PubMed  Google Scholar 

  39. Petri, M., Perez-Gutthann, S., Spence, D. & Hochberg, M. C. Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am. J. Med. 93, 513–519 (1992).

    Article  CAS  PubMed  Google Scholar 

  40. Manzi, S. et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am. J. Epidemiol. 145, 408–415 (1997).

    Article  CAS  PubMed  Google Scholar 

  41. Gladman, D. D. & Urowitz, M. B. Morbidity in systemic lupus erythematosus. J. Rheumatol. Suppl. 14 (Suppl. 13), 223–226 (1987).

    PubMed  Google Scholar 

  42. Drewes, Y. M. et al. Homocysteine levels and treatment effect in the PROspective study of pravastatin in the elderly at risk. J. Am. Geriatr. Soc. 62, 213–221 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Sattar, N. et al. Are markers of inflammation more strongly associated with risk for fatal than for nonfatal vascular events? PLoS Med. 6, e1000099 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Pertovaara, M. et al. Autoimmunity and atherosclerosis: the presence of antinuclear antibodies is associated with decreased carotid elasticity in young women. The Cardiovascular Risk in Young Finns Study. Rheumatology (Oxford) 48, 1553–1556 (2009).

    Article  CAS  Google Scholar 

  45. Agmon-Levin, N. & Selmi, C. The autoimmune side of heart and lung diseases. Clin. Rev. Allergy Immunol. 44, 1–5 (2013).

    Article  CAS  PubMed  Google Scholar 

  46. Simonini, G. et al. Oxidative stress in systemic sclerosis. Mol. Cell. Biochem. 196, 85–91 (1999).

    Article  CAS  PubMed  Google Scholar 

  47. Bruckdorfer, K. R., Hillary, J. B., Bunce, T., Vancheeswaran, R. & Black, C. M. Increased susceptibility to oxidation of low-density lipoproteins isolated from patients with systemic sclerosis. Arthritis Rheum. 38, 1060–1067 (1995).

    Article  CAS  PubMed  Google Scholar 

  48. Cheng, K. S. et al. Carotid and femoral arterial wall mechanics in scleroderma. Rheumatology (Oxford) 42, 1299–1305 (2003).

    Article  Google Scholar 

  49. Artenjak, A. et al. Antiphospholipid antibodies as non-traditional risk factors in atherosclerosis based cardiovascular diseases without overt autoimmunity. A critical updated review. Autoimmun. Rev. 11, 873–882 (2012).

    Article  CAS  PubMed  Google Scholar 

  50. Shoenfeld, Y., Harats, D. & George, J. Atherosclerosis and the antiphospholipid syndrome: a link unravelled? Lupus 7 (Suppl. 2), S140–S143 (1998).

    Article  PubMed  Google Scholar 

  51. Jara, L. J., Medina, G. & Vera-Lastra, O. Systemic antiphospholipid syndrome and atherosclerosis. Clin. Rev. Allergy Immunol. 32, 172–177 (2007).

    Article  CAS  PubMed  Google Scholar 

  52. Jara, L. J., Medina, G., Vera-Lastra, O. & Shoenfeld, Y. Atherosclerosis and antiphospholipid syndrome. Clin. Rev. Allergy Immunol. 25, 79–88 (2003).

    Article  CAS  PubMed  Google Scholar 

  53. Danowski, A., Kickler, T. S. & Petri, M. Anti-beta2-glycoprotein I: prevalence, clinical correlations, and importance of persistent positivity in patients with antiphospholipid syndrome and systemic lupus erythematosus. J. Rheumatol. 33, 1775–1779 (2006).

    CAS  PubMed  Google Scholar 

  54. Wick, G. et al. Atherosclerosis, autoimmunity, and vascular-associated lymphoid tissue. FASEB J. 11, 1199–1207 (1997).

    Article  CAS  PubMed  Google Scholar 

  55. Perez-Villa, F. et al. Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term, followup study. Arthritis Rheum. 53, 460–467 (2005).

    Article  PubMed  Google Scholar 

  56. Yiu, K. H. et al. Relationship between cardiac valvular and arterial calcification in patients with rheumatoid arthritis and systemic lupus erythematosus. J. Rheumatol. 38, 621–627 (2011).

    Article  PubMed  Google Scholar 

  57. Guedes, C. et al. Cardiac manifestations of rheumatoid arthritis: a case-control transesophageal echocardiography study in 30 patients. Arthritis Rheum. 45, 129–135 (2001).

    Article  CAS  PubMed  Google Scholar 

  58. Moyssakis, I. et al. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am. J. Med. 120, 636–642 (2007).

    Article  PubMed  Google Scholar 

  59. Bulkley, B. H. & Roberts, W. C. The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. A study of 36 necropsy patients. Am. J. Med. 58, 243–264 (1975).

    Article  CAS  PubMed  Google Scholar 

  60. Galve, E. et al. Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus. N. Engl. J. Med. 319, 817–823 (1988).

    Article  CAS  PubMed  Google Scholar 

  61. Roldan, C. A., Chavez, J., Wiest, P. W., Qualls, C. R. & Crawford, M. H. Aortic root disease and valve disease associated with ankylosing spondylitis. J. Am. Coll. Cardiol. 32, 1397–1404 (1998).

    Article  CAS  PubMed  Google Scholar 

  62. Arnason, J. A., Patel, A. K., Rahko, P. S. & Sundstrom, W. R. Transthoracic and transesophageal echocardiographic evaluation of the aortic root and subvalvular structures in ankylosing spondylitis. J. Rheumatol. 23, 120–123 (1996).

    CAS  PubMed  Google Scholar 

  63. Owlia, M. B., Mostafavi Pour Manshadi, S. M. & Naderi, N. Cardiac manifestations of rheumatological conditions: a narrative review. ISRN Rheumatol. 2012, 463620 (2012).

    PubMed  PubMed Central  Google Scholar 

  64. Nicola, P. J. et al. The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum. 52, 412–420 (2005).

    Article  PubMed  Google Scholar 

  65. Bhatia, G. S. et al. Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden? J. Am. Coll. Cardiol. 47, 1169–1174 (2006).

    Article  PubMed  Google Scholar 

  66. Corrao, S. et al. Echo-Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease. Eur. J. Clin. Invest. 26, 293–297 (1996).

    Article  CAS  PubMed  Google Scholar 

  67. Champion, H. C. The heart in scleroderma. Rheum. Dis. Clin. North Am. 34, 181–190 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  68. Maione, S. et al. Echocardiographic alterations in systemic sclerosis: a longitudinal study. Semin. Arthritis Rheum. 34, 721–727 (2005).

    Article  PubMed  Google Scholar 

  69. Hurd, E. R. Extraarticular manifestations of rheumatoid arthritis. Semin. Arthritis Rheum. 8, 151–176 (1979).

    Article  CAS  PubMed  Google Scholar 

  70. Hara, K. S., Ballard, D. J., Ilstrup, D. M., Connolly, D. C. & Vollertsen, R. S. Rheumatoid pericarditis: clinical features and survival. Medicine (Baltimore) 69, 81–91 (1990).

    Article  CAS  Google Scholar 

  71. Cervera, R. et al. Cardiac disease in systemic lupus erythematosus: prospective study of 70 patients. Ann. Rheum. Dis. 51, 156–159 (1992).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Crozier, I. G., Li, E., Milne, M. J. & Nicholls, M. G. Cardiac involvement in systemic lupus erythematosus detected by echocardiography. Am. J. Cardiol. 65, 1145–1148 (1990).

    Article  CAS  PubMed  Google Scholar 

  73. Klinkhoff, A. V., Thompson, C. R., Reid, G. D. & Tomlinson, C. W. M-mode and two-dimensional echocardiographic abnormalities in systemic lupus erythematosus. JAMA 253, 3273–3277 (1985).

    Article  CAS  PubMed  Google Scholar 

  74. Seferovic, P. M. et al. Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases. Rheumatology (Oxford) 45 (Suppl. 4), iv39–iv42 (2006).

    Article  Google Scholar 

  75. Urowitz, M. B., Gladman, D. D., Abu-Shakra, M. & Farewell, V. T. Mortality studies in systemic lupus erythematosus. Results from a single center. III. Improved survival over 24 years. J. Rheumatol. 24, 1061–1065 (1997).

    CAS  PubMed  Google Scholar 

  76. Kitas, G. D. & Gabriel, S. E. Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives. Ann. Rheum. Dis. 70, 8–14 (2011).

    Article  PubMed  Google Scholar 

  77. Wislowska, M., Sypula, S. & Kowalik, I. Echocardiographic findings and 24-h electrocardiographic Holter monitoring in patients with nodular and non-nodular rheumatoid arthritis. Rheumatol. Int. 18, 163–169 (1999).

    Article  CAS  PubMed  Google Scholar 

  78. Voskuyl, A. E. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford) 45 (Suppl. 4), iv4–iv7 (2006).

    Article  Google Scholar 

  79. Evrengul, H. et al. Heart rate variability in patients with rheumatoid arthritis. Rheumatol. Int. 24, 198–202 (2004).

    Article  PubMed  Google Scholar 

  80. Chen, C. Y., Wang, F. L. & Lin, C. C. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin. Toxicol. (Phila.) 44, 173–175 (2006).

    Article  Google Scholar 

  81. Lazzerini, P. E. et al. Prolongation of the corrected QT interval in adult patients with anti-Ro/SSA-positive connective tissue diseases. Arthritis Rheum. 50, 1248–1252 (2004).

    Article  PubMed  Google Scholar 

  82. Lazzerini, P. E. et al. Anti-Ro/SSA-associated corrected QT interval prolongation in adults: the role of antibody level and specificity. Arthritis Care Res. (Hoboken) 63, 1463–1470 (2011).

    Article  CAS  Google Scholar 

  83. Guzman, J., Cardiel, M. H., Arce-Salinas, A. & Alarcon-Segovia, D. The contribution of resting heart rate and routine blood tests to the clinical assessment of disease activity in systemic lupus erythematosus. J. Rheumatol. 21, 1845–1848 (1994).

    CAS  PubMed  Google Scholar 

  84. Kostis, J. B. et al. Prognostic importance of cardiac arrhythmias in systemic sclerosis. Am. J. Med. 84, 1007–1015 (1988).

    Article  CAS  PubMed  Google Scholar 

  85. Rokas, S. et al. Electrophysiologic abnormalities of cardiac function in progressive systemic sclerosis. J. Electrocardiol. 29, 17–25 (1996).

    Article  CAS  PubMed  Google Scholar 

  86. Bergfeldt, L., Vallin, H. & Edhag, O. Complete heart block in HLA B27 associated disease. Electrophysiological and clinical characteristics. Br. Heart J. 51, 184–188 (1984).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Choi, H. K., Hernan, M. A., Seeger, J. D., Robins, J. M. & Wolfe, F. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 359, 1173–1177 (2002).

    Article  CAS  PubMed  Google Scholar 

  88. Westlake, S. L. et al. The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 49, 295–307 (2010).

    Article  CAS  Google Scholar 

  89. Guin, A., Chatterjee Adhikari, M., Chakraborty, S., Sinhamahapatra, P. & Ghosh, A. Effects of disease modifying anti-rheumatic drugs on subclinical atherosclerosis and endothelial dysfunction which has been detected in early rheumatoid arthritis: 1-year follow-up study. Semin. Arthritis Rheum. 43, 48–54 (2013).

    Article  CAS  PubMed  Google Scholar 

  90. Peters, M. J. et al. The effects of tumor necrosis factor inhibitors on cardiovascular risk in rheumatoid arthritis. Curr. Pharm. Des. 18, 1502–1511 (2012).

    Article  CAS  PubMed  Google Scholar 

  91. Avouac, J. & Allanore, Y. Cardiovascular risk in rheumatoid arthritis: effects of anti-TNF drugs. Expert Opin. Pharmacother. 9, 1121–1128 (2008).

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Megha Prasad, Joerg Hermann, Sharon Mulvagh, Rekha Mankad, Jae K. Oh & Amir Lerman

  2. Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Sherine E. Gabriel & Eric L. Matteson

  3. Division of Rheumatology, Stanford University, 300 Pasteur Drive, A100 MC5309, Stanford, 94305, CA, USA

    Cornelia M. Weyand

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M.P., J.H., S.E.G., C.M.W., S.M., R.M., J.K.O., and E.L.M. researched data for the article and made substantial contributions to the content; M.P. wrote the manuscript; M.P. and A.L. reviewed and edited the manuscript before submission.

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Prasad, M., Hermann, J., Gabriel, S. et al. Cardiorheumatology: cardiac involvement in systemic rheumatic disease. Nat Rev Cardiol 12, 168–176 (2015). https://doi.org/10.1038/nrcardio.2014.206

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