Vnitr Lek 2018, 64(1):51-59 | DOI: 10.36290/vnl.2018.008

Cardiovascular risk in patients with rheumatic disease and its management

Jiří Laštůvka^1,*, Sabína Oreská², Michal Tomčík², Michal Vrablík³

¹ Interní oddělení Masarykovy nemocnice v Ústí nad Labem, o.z., Krajská zdravotní a.s.

² Revmatologický ústav a Revmatologická klinika 1. LF UK a VFN v Praze

³ III. interní klinika - klinika endokrinologie a metabolizmu 1. LF UK a VFN v Praze

Cardiovascular disease (CVD) risk in patients with rheumatic diseases is increased by 50 % compared to the general population. This is a result of the increased inflammatory activity as well as modification of traditional CVD risk factors by the primary disease. So called lipid paradox, paradoxical decrease of concentrations of atherogenic plasma lipids due to increased inflammatory activity and their rise with successful anti-inflammatory treatment, is of particular importance. CVD risk in rheumatic diseases is further modified by drugs used for their treatment: while some treatment modalities increase the risk (e.g. glucocorticoids), others may act in an opposite direction (methotrexate, biological therapies). CVD risk stratification in patients with rheumatic diseases is uneasy; so far none of the specific scoring systems has been shown superior to traditional ones designed for the general population. Principles of cardiovascular risk intervention remain the same as for the general population: the management starts with lifestyle measures (healthy diet, increase in physical activity and smoking cessation) complemented with pharmacotherapy when indicated. Blood pressure as well as lipid lowering therapies should be led according to the same principles as in the general population and, also, to the same treatment goals. To improve CVD prevention outcomes in patients with rheumatic diseases it seems feasible to work in interdisciplinary teams led by a rheumatologist cooperating with a specialist in CVD prevention strategies (general practitioner, cardiologist, internist, diabetes specialist). A nutritional therapist and a physiotherapist are important members of the team, too. Interdisciplinary and complex CVD prevention in patients with rheumatic diseases decreases CVD morbidity.

Keywords: cardiovascular risk; intervention; lipid paradox; rheumatic diseases; risk factors; risk stratification

Received: December 30, 2017; Accepted: January 5, 2018; Published: January 1, 2018  Show citation