REVIEW - The impact of metabolic syndrome on cardiovascular risk and disease in RA

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From Future Rheumatology

Posted 10/10/2008

The Impact of the Metabolic Syndrome on Cardiovascular Risk and

Disease in Rheumatoid Arthritis

H. Dessein; A. -Gay; J. Woodiwiss; Barry

I. Joffe; Gavin R. Norton; Ahmed

Abstract

The metabolic syndrome is a cluster of cardiovascular risk factors

that are of metabolic origin and include atherogenic dyslipidemia,

hypertension and hyperglycemia. This syndrome is generally considered

to develop as a consequence of excess adiposity- mediated insulin

resistance. In rheumatoid arthritis (RA), apart from excess adiposity,

high-grade inflammation, routine glucocorticoid use and subclinical

hypothyroidism are further implicated in insulin resistance. Several

more recently uncovered metabolic risk factors including

microalbuminuria, hypercoagulability, autonomic dysfunction,

hyperuricemia, renin-angiotensin activation and raised

aminotransferase concentrations prior to methotrexate use are also

more prevalent in RA subjects as compared with non-RA subjects, linked

to other metabolic syndrome components and/or related to RA

characteristics. Suppression of RA disease activity improves metabolic

cardiovascular risk. Systemic inflammation, glucocorticoid therapy,

hypothyroidism, insulin resistance, atherogenic dyslipidemia,

hypertension, hypercoagulability, hyperuricemia and raised

aminotransferases are each further associated with cardiovascular

disease in RA. However, the WHO and the National Cholesterol Education

Program defined metabolic syndrome as less strongly associated with

atherosclerosis than their components. We propose that individual

metabolic risk factors should be considered in the assessment and

interventions aimed at reducing cardiovascular risk in this disease.

Future prospective investigations need to elucidate molecular

mechanisms that account for the interactions between RA

characteristics and metabolic risk factors, as well as the relative

importance of altering adverse lifestyle factors and intensifying

disease activity suppressant therapy in patients with controlled and

uncontrolled RA disease activity.

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Read the entire article here:

http://www.medscape.com/viewarticle/581366

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