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Patients with inflammatory joint diseases (IJDs) have an increased risk of cardiovascular disease (CVD), which is of similar magnitude as for patients with diabetes; approximately twice as high as in the general population. Recommendations for CVD risk management for patients with IJD have been published, suggesting that initiation of lipid lowering treatment should follow national guidelines developed for the general population. Available cardiovascular (CV) risk calculators for the general population underestimate future CV events in patients with rheumatoid arthritis (RA). The underestimation of CV risk may have several reasons: (1) systemic inflammation (2) a lipid paradox which has been described for patients with RA, whereby lower total cholesterol and low-density lipoprotein cholesterol were associated with increased risk of CV morbidity and mortality (3) the high frequency of asymptomatic carotid plaques (CP) in patients with RA In the recent European guidelines for CVD prevention, CP is considered a very high CVD risk factor; a CVD equivalent. Therefore, it is recommended to initiate intensive lipid lowering treatment with statins when CP has been identified in a patient. The current evidence on lipid lowering treatment in patients with IJD will be discussed. |
