Background/Purpose: Patients with rheumatoid arthritis (RA) (and other inflammatory joint diseases (IJD)) have an increased cardiovascular (CV) risk. In 2009 a EULAR taskforce recommended screening, identification of CV risk factors and cardiovascular risk management (CV-RM) largely based on expert opinion. In view of substantial new evidence, an update appeared timely with the aim of producing a more evidence base set of CV-RM recommendations. 

Objectives:To  1) Review the presently available RA-specific cardiovascular risk prediction models and advise about the most appropriate model(s), 2a) Assess whether imaging techniques can improve CV risk prediction models, and b) advise whether routine screening with echocardiography before biologic therapy is initiated is indicated. 3) Give recommendations about lipid assessment, lipid lowering treatment and treatment targets, 4) Give recommendations about life style modifications. 5) Conduct a systematic literature update to determine the CV risk in AS and PsA and 6) Update the  recommendation on NSAID/COXIB use in patients with IJD.

Methods: The multidisciplinary steering committee comprised 25 members including patients, rheumatologists, cardiologists, internists, epidemiologists and a health professional, representing 15 European countries. Systematic literature searches were done, evidence was categorized according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process  and ultimately 10 evidence based recommendations for CV-RM were formulated. 

Results: 1) Validated RA-specific CV-risk models have not yet been published, hence adjustment of general population risk models is still recommended 2) There are some suggestions that (imaging) biomarkers might improve risk prediction models. However, there are practical constraints for implementation. Echocardiographic screening before initiation of biologic treatment is not recommended. 3) Statins are at least as effective and safe in RA patients as in non-RA controls. 4) Exercise should be part of RA management, both to lower CV risk and improve disease outcomes. Counselling for smoking cessation should be considered 5) There is now more evidence for an increased CV-risk in patients with AS and PsA that is comparable to RA. Systemic inflammation enhances CV risk and adequate control of disease activity good control of disease activity is likely to be beneficial. 6) Current evidence does not support a strong association between NSAID use and CVD in patients with IJD. As in the general population, the use of aspirin for the primary prevention of CV events in patients with IJD is not recommended. Level of agreement for the 10 recommendations varied but was generally high.  

Conclusion:  The present update confirms and further extends the evidence that the CV-risk in the whole spectrum of IJD is increased. This underscores the need for CV-RM in these patients. As these updated recommendations are based on a pan-European consensus it is hoped that they will facilitate CV-RM in daily clinical practice, ultimately leading to a decreased CV burden in our patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/eular-recommendations-for-cardiovascular-risk-management-in-patients-with-rheumatoid-arthritis-and-other-inflammatory-joint-diseases-2015-update/