INFO - Cardiovascular risk and RA: clinical practice guidelines based on published evidence and expert opinion

[Guest guest]

Joint Bone Spine. 2006 Jul;73(4):379-87. Epub 2006 Mar 29.

Cardiovascular risk and rheumatoid arthritis: clinical practice guidelines

based on published evidence and expert opinion.

Service de rhumatologie, CHU de la Conception, Marseille, France.

OBJECTIVE: To develop clinical practice guidelines for the evaluation and

management of cardiovascular risk in patients with rheumatoid arthritis

(RA), using the evidence-based approach and expert opinion. METHODS:

Recommendations were developed using the evidence-based approach and expert

opinion: A scientific committee used a Delphi procedure to select five

questions, which formed the basis for developing the recommendations;

Evidence providing answers to the five questions was sought in the

literature; Based on this evidence, recommendations were developed by a

panel of experts. RESULTS: The recommendations were as follows:

1) In patients with RA, attention should be given to the risk of

cardiovascular disease, which is responsible for an excess burden of

morbidity and mortality;

2) It must be recognized that RA may be an independent cardiovascular risk

factor. Persistent inflammation is an additional risk factor;

3) The cardiovascular risk should be evaluated, and modifiable risk factors

should be corrected;

4) In patients with RA requiring glucocorticoid therapy, the need for

cardiovascular risk minimization is among the reasons that mandate the use

of the minimal effective dose;

5) It should be recognized that methotrexate may protect against

cardiovascular mortality in patients with RA;

6) It should be recognized that TNFalpha antagonists remain contraindicated

in patients with RA and severe heart failure. TNFalpha antagonists do not

seem to worsen moderate heart failure and may protect against cardiovascular

mortality;

7) AFSSAPS recommendations about LDL-cholesterol objectives should be

followed, with active RA being counted as a cardiovascular risk factor;

8) In patients with RA, statin therapy should be considered only when

cholesterol levels are elevated despite appropriate dietary treatment;

9) RA per se does not indicate aspirin for primary prevention. When aspirin

is used for secondary prevention, it should be recognized that concomitant

treatment with nonsteroidal antiinflammatory drugs (NSAIDs) may decrease the

antiplatelet effects and increase the gastrointestinal side effects of

aspirin therapy.

PMID: 16690341

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16690341

Not an MD