Management of CV Risk in Patients with Chronic Inflammatory Diseases

Methods:

This article is a systematic literature review of studies that have shown an association of increased risk of CV events in patients with chronic inflammatory diseases.

Results:

There are approximately 11 studies reviewed here that demonstrate an increased risk of CV events in patient with chronic inflammatory diseases, such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, and systemic lupus erythematosus. It appears that pro-inflammatory cytokines may contribute to this increased risk by promoting dyslipidemia, insulin resistance, and oxidative stress. These patients appear to have a higher number of traditional CV risk factors that may also contribute to their overall risk. However, general CV risk factors may not accurately predict the overall CV risk in this patient population, and many of treatments for the chronic diseases such as steroids and cyclosporine may add to this risk. Finally, studies have shown that patients with chronic inflammatory diseases are often undertreated with evidence-based medications, which may hinder the ability to optimally reduce CV risk in patients with chronic inflammatory diseases.

Conclusions:

Studies appear to show an association of increased CV risk in patients with chronic inflammatory diseases. The treatment options for these patients often include medications that may further increase this risk, and current risk stratification tools may not be optimal in these patients and may lead to undertreatment. Two studies are underway to evaluate the effects of Interleukin 1, Beta inhibition and methotrexate on the impact of CV events by reducing inflammation in patients with stable coronary disease. Additional trials are also being conducted to evaluate the impact of different treatment modalities on CV events in patients with chronic inflammatory diseases.

Perspective:

Several studies show an association between increased CV risk and patients with chronic inflammatory diseases, but there are a number of variables that place patients with chronic inflammatory diseases at higher risk. One of the primary drivers is inflammation, and although some treatments for chronic inflammatory disease reduce inflammation, their role in reducing CV risk has not been fully elucidated. More studies are underway that may draw a clearer line of association of increased CV risk and identify ways to modify or reduce the risk of CV events in these complex patients.

Clinical Topics: Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Prevention

Keywords: Cardiovascular Diseases, Chronic Disease, Coronary Artery Disease, Cyclosporine, Cytokines, Dyslipidemias, Inflammation, Interleukin-1beta, Methotrexate, Risk Factors, Primary Prevention


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