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Cardiovascular Disease Risk in Older Adults and Elderly Patients with Rheumatoid Arthritis: What Role Can Disease-Modifying Antirheumatic Drugs Play in Cardiovascular Risk Reduction?

Author

Day AL1, Singh JA2,3,4,5. Drugs Aging. 2019 Apr 5. doi: 10.1007/s40266-019-00653-0. [Epub ahead of print]

Author Information

1 Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA.

2 Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA. Jasvinder.md@gmail.com.

3 Medicine Service, VA Medical Center, 510, 20th Street South, FOT 805B, Birmingham, AL, USA. Jasvinder.md@gmail.com.

4 Department of Epidemiology at the UAB School of Public Health, 1665 University Blvd, Ryals Public Health Building, Room 220, Birmingham, AL, 35294-0022, USA. Jasvinder.md@gmail.com.

5 University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. Jasvinder.md@gmail.com.

Abstract

The prevalence of rheumatoid arthritis (RA), the most common autoimmune inflammatory arthritis, is increasing, partly due to the aging of the general population. RA is an independent risk factor for the development of cardiovascular disease (CVD). Older adults and elderly patients with RA develop CVD at a younger age compared with their general population peers. Both the traditional cardiovascular risk factors (age, sex, smoking, diabetes mellitus, hypertension), and systemic inflammation (i.e. high disease activity) are contributors to accelerated CVD in people with RA. Of the disease-modifying antirheumatic drugs (DMARDs) used for RA treatment, methotrexate, triple combination oral therapy (methotrexate, sulfasalazine, and hydroxychloroquine), tumor necrosis factor inhibitor biologicals, and abatacept have the strongest data in favor of the reduction of cardiovascular events in patients with RA. A treat-to-target strategy should be employed in older adults and elderly patients with RA to ensure appropriate reduction in cardiovascular risk, which can also prevent short- and long-term musculoskeletal disability. Our review findings are in line with the 2016 European League Against Rheumatism guideline recommendations, specifically: (1) RA disease activity should be controlled with an optimal DMARD regimen using a treat-to-target approach; (2) the lipid profile should be assessed and monitored in every older adult and elderly RA patient; (3) CVD risk factors, including smoking cessation, blood pressure, and blood glucose control, should be optimized; (4) RA treatment should be initiated as soon as possible; and (5) shared decision making regarding the treatment of patients with RA should include a discussion on the potential amelioration of increased cardiovascular risk.