Cardiovascular risk in rheumatoid arthritis

The increased mortality in rheumatoid arthritis (RA) is mainly due to (atherosclerotic) cardiovascular disease. The cardiovascular morbidity is also increased in comparison with the general population. This increased cardiovascular burden could be caused by 1) an enhanced prevalence of cardiovascular risk factors 2) under treatment of cardiovascular risk factors or 3) RA itself, particularly due to its chronic inflammatory component. Cardiovascular risk factors only partially explain the increased cardiovascular risk and it is becoming increasingly acknowledged that the underlying inflammation in RA plays an essential role. This is probably related to the fact that atherosclerosis also has an inflammatory etiology that is accelerated by RA. Similarly, it can be expected that effective suppression of this inflammatory process by disease modifying antirheumatic drugs and/or biologicals lowers the cardiovascular risk. Altogether, there is accumulating evidence that the increased cardiovascular risk in RA is comparable to that of type 2 diabetes and actually RA should be seen as a new, independent, cardiovascular risk factor for which cardiovascular risk management is essential.