Updated EULAR Recommendations on Cardiovascular Disease in RA

EULAR has just released its 2015 update on cardiovascular disease which was last updated in 2009/2010. Although widely recognized as a comorbidity of chronic inflammatory conditions, assessment and preventative treatment measures to address cardiovascular risk are generally poorly done.

EULAR's list of 11 recommendations include the following:

• RA should be regarded as a condition associated with higher risk for cardiovascular disease.

• Cardiovascular risk is a combination of both an increased prevalence of traditional CV risk factors and inflammatory burden.

• AS and PsA are both officially recognized as being associated with increased mortality and an increased prevalence of CV risk. Early treatment of disease to reduce inflammation is needed to lower CV risk in RA, PsA and AS.

• Measuring lipid levels is best done when the disease is stable since active inflammation can lower lipid levels resulting in a false sense of risk.

• Adding a factor of 1.5 to CV risk calculations is recommended.

• The SCORE risk assessment is recommended unless there is an established national scoring guideline.

• NSAIDs can be used in RA patients as needed as their risk seems lower than in the general population.

• Steroid dosing is to be kept to a minimum to reduce CV risk.

• As always, lifestyle modifications including a healthy diet, exercise and smoking cessation are to be encouraged.

The only recommendation which received a lower level of consensus from the committee was screening for asymptomatic atherosclerotic plaque using carotid U/S. Although this met with mixed opinion, it did make the recommendations list.

Adding statin therapy to all patients with chronic inflammatory disease is not currently supported by EULAR. Risk assessment tools (adding the 1.5 increased factor of risk) should drive the choice for statin therapy according to their current recommendations. Previous sessions at ACR questioned the validity of risk assessment tools, leaving the practitioner to once again utilize their professional judgment.

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