Letter to the Editor
Rheumatoid Arthritis, a New Focus on Cardiovascular Risk
Artritis reumatoide, un nuevo enfoque del riesgo cardiovascular
Erardo Meriño-Ibarra
, Concepción Delgado-Beltrán
Corresponding author
Sección de Reumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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A propósito de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1660 "Ancho" => 2500 "Tamanyo" => 259766 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Longitudinal view of the palmar radiocarpal joint, in which the flexor tendons of the wrist are appreciated. A hypoechoic thickening of the synovial sheaths of the tendons is highlighted, corresponding to tenosynovitis with marked synovial hypertrophy and a pathological Doppler signal, which shows an increase of normal vasculature.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Manuel Feced Olmos, José Ivorra Cortés, Rosa Negueroles Albuixech, José Andrés Román Ivorra" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Carlos Manuel" "apellidos" => "Feced Olmos" ] 1 => array:2 [ "nombre" => "José" "apellidos" => "Ivorra Cortés" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "Negueroles Albuixech" ] 3 => array:2 [ "nombre" => "José Andrés" "apellidos" => "Román Ivorra" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X14001685" "doi" => "10.1016/j.reuma.2014.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14001685?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315000271?idApp=UINPBA00004M" "url" => "/21735743/0000001100000002/v2_201502230158/S2173574315000271/v2_201502230158/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Rheumatoid Arthritis, a New Focus on Cardiovascular Risk" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "129" "paginaFinal" => "130" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Erardo Meriño-Ibarra, Concepción Delgado-Beltrán" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Erardo" "apellidos" => "Meriño-Ibarra" "email" => array:1 [ 0 => "erardomerino@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Concepción" "apellidos" => "Delgado-Beltrán" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Reumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artritis reumatoide, un nuevo enfoque del riesgo cardiovascular" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patients with rheumatoid arthritis (RA) have a greater prevalence of traditional risk factors and 68% more risk of developing a myocardial infarction<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> than the general population, with this risk persisting even when the analysis is adjusted for traditional coronary risk factors.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> EULAR<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> recommendations for the evaluation of cardiovascular risk in subjects with RA propose the application of risk evaluation methods such as, for example, the Framingham type. On the other hand, EULAR recommends special attention to subjects with long-standing RA (over 10 years), rheumatoid factor or anti-CCP antibody positivity as well as those with extra articular manifestations.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Rheumatologists, in their daily clinical practice, must perform different indices: diagnostic, classification, disease activity, radiological progression, risk for fracture due to frailty (FRAX and others), patient quality of life, etc., to which we add the evaluation of coronary risk.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> were recently published, which propose “extensive and consistent” evidence on the benefit of the use of statins in order to reduce the cardiovascular risk in subjects with LDLc over 70<span class="elsevierStyleHsp" style=""></span>mg/dL. Four groups of patients are identified in subjects who would benefit from the use of statins: (1) subjects with clinical cardiovascular disease; (2) subjects with LDLc≥190<span class="elsevierStyleHsp" style=""></span>mg/dL; (3) diabetics between 40 and 75 years of age with LDLc between 70 and 189<span class="elsevierStyleHsp" style=""></span>mg/dL and no clinical cardiovascular disease, and (4) subjects with no clinical cardiovascular disease or diabetes, with LDLc between 70 and 189<span class="elsevierStyleHsp" style=""></span>mg/dL and a 10 year estimated risk of ≥7.5%.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Because RA has a cardiovascular risk similar to diabetes mellitus,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> that the use of statins provide a modest but significant anti-inflammatory effect,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and that the use of anti-inflammatory drugs (coxibs or non-coxibs) is associated to a greater coronary risk,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> we propose that subjects with RA and no clinical cardiovascular disease, with LDLc between 70 and 189<span class="elsevierStyleHsp" style=""></span>mg/dL and no upper limit for age be considered in group 3 of the four abovementioned groups, which implies the use of statins in “moderate intensity”<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> for most of the patients with RA; however, in subjects with long-standing RA who are rheumatoid factor/anti-CCP positive or have extra articular manifestations who comply with two or more of these criteria, the clinician might consider the use of “high intensity” statin treatment.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These recommendations might be extended to subjects with spondyloarthritis, including psoriatic arthritis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of statins modifies the plasma lipid profile and the cardiovascular risk of subjects with inflammatory arthritis in a similar way than in patients without inflammatory arthropathy and this reduction of extended to RA, spondylitis and psoriatic arthritis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>; even in subjects with RA who are using statins, the interruption in treatment is associated to an increase in the risk of cardiovascular mortality.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In spite of the benefits in cardiovascular risk that, in our judgment, would be provided by statins in subjects with inflammatory arthritides, the clinician must always take into account the possibility of myopathy and especially liver toxicity that may occur in subjects who frequently take other hepatotoxic drugs.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, we recommend that all patients with inflammatory arthritis, especially RA, over 40 years of age, with LDLc between 70 and 189<span class="elsevierStyleHsp" style=""></span>mg/dL and no cardiovascular disease receive statins at a moderate dose and those patients with a particularly high risk (two or more of these conditions: long-standing RA, rheumatoid factor/anti-CCP positivity, extra articular manifestations) receive statins in a high intensity regimen.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Meriño-Ibarra E, Delgado-Beltrán C. Artritis reumatoide, un nuevo enfoque del riesgo cardiovascular. Reumatol Clin. 2015;11:129–130.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.A. Avina-Zubieta" 1 => "J. Thomas" 2 => "M. Sadatsafavi" 3 => "A.J. Lehman" 4 => "D. 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| 2022 August | 26 | 38 | 64 |
| 2022 July | 29 | 30 | 59 |
| 2022 June | 26 | 31 | 57 |
| 2022 May | 31 | 35 | 66 |
| 2022 April | 34 | 43 | 77 |
| 2022 March | 46 | 58 | 104 |
| 2022 February | 23 | 29 | 52 |
| 2022 January | 29 | 31 | 60 |
| 2021 December | 26 | 35 | 61 |
| 2021 November | 28 | 48 | 76 |
| 2021 October | 51 | 49 | 100 |
| 2021 September | 29 | 46 | 75 |
| 2021 August | 26 | 46 | 72 |
| 2021 July | 55 | 32 | 87 |
| 2021 June | 25 | 29 | 54 |
| 2021 May | 39 | 38 | 77 |
| 2021 April | 71 | 80 | 151 |
| 2021 March | 39 | 21 | 60 |
| 2021 February | 25 | 19 | 44 |
| 2021 January | 16 | 14 | 30 |
| 2020 December | 36 | 25 | 61 |
| 2020 November | 12 | 35 | 47 |
| 2020 October | 15 | 8 | 23 |
| 2020 September | 85 | 31 | 116 |
| 2020 August | 64 | 13 | 77 |
| 2020 July | 31 | 12 | 43 |
| 2020 June | 25 | 22 | 47 |
| 2020 May | 42 | 18 | 60 |
| 2020 April | 22 | 15 | 37 |
| 2020 March | 14 | 9 | 23 |
| 2020 February | 1 | 0 | 1 |
| 2019 February | 2 | 0 | 2 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 50 | 4 | 54 |
| 2018 March | 72 | 4 | 76 |
| 2018 February | 32 | 2 | 34 |
| 2018 January | 37 | 3 | 40 |
| 2017 December | 45 | 2 | 47 |
| 2017 November | 33 | 5 | 38 |
| 2017 October | 32 | 6 | 38 |
| 2017 September | 24 | 4 | 28 |
| 2017 August | 37 | 7 | 44 |
| 2017 July | 40 | 8 | 48 |
| 2017 June | 54 | 11 | 65 |
| 2017 May | 58 | 12 | 70 |
| 2017 April | 43 | 9 | 52 |
| 2017 March | 41 | 8 | 49 |
| 2017 February | 23 | 5 | 28 |
| 2017 January | 35 | 5 | 40 |
| 2016 December | 54 | 19 | 73 |
| 2016 November | 39 | 4 | 43 |
| 2016 October | 60 | 9 | 69 |
| 2016 September | 48 | 9 | 57 |
| 2016 August | 43 | 4 | 47 |
| 2016 July | 29 | 7 | 36 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 1 | 16 | 17 |
| 2015 October | 1 | 18 | 19 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 88 | 7 | 95 |
| 2015 June | 51 | 10 | 61 |
| 2015 May | 76 | 20 | 96 |
| 2015 April | 105 | 28 | 133 |
| 2015 March | 85 | 26 | 111 |
| 2015 February | 12 | 6 | 18 |
Show all
