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Cardiovascular disease in rheumatoid arthritis: disease and treatment interactions and their implications on treatment decisions.

Cardiovascular disease is highly prevalent in rheumatoid arthritis patients, contributing to significant morbidity and mortality. Few randomized trials are available to guide risk assessment and intervention in these complex patients. This paper discusses traditional atherosclerotic and rheumatoid-related risk factors for cardiovascular disease in these patients, reviews the effect of treatment of cardiovascular risk factors on rheumatoid arthritis activity, and describes the effect of rheumatoid arthritis treatment on risk factors for cardiovascular disease. The authors reviewed the existing literature by cross-referencing topics such as cardiovascular disease, rheumatoid arthritis, various risk factors for cardiovascular disease and their treatments, and treatments for rheumatoid arthritis, using Medline and PubMed, reviewing references from 1983-2009. Traditional and rheumatoid-related risk factors (including active inflammation/disease activity and some medications) contribute to this high prevalence of cardiovascular disease in rheumatoid arthritis. Evidence supports aggressive therapy for traditional cardiovascular risk factors, reducing rheumatoid activity, and limiting pro-atherosclerotic medications.