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Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

  • Rheumatoid Arthritis (L Moreland, Section Editor)
  • Published:
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Abstract

ᅟ

The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear.

Purpose of Review

By critically reviewing literature published within the past 5 years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA.

Recent Findings

We examine recent guidelines, recommendations, and evidence and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity, and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA.

Summary

This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Torp-Pedersen C, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis. 2011;70(6):929–34.

    Article  PubMed  Google Scholar 

  2. Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71(9):1524–9.

    Article  PubMed  Google Scholar 

  3. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Stat 13. 2007;2011(169):1–38.

    Google Scholar 

  4. Avalos I, Chung CP, Oeser A, Gebretsadik T, Shintani A, Kurnik D, et al. Increased augmentation index in rheumatoid arthritis and its relationship to coronary artery atherosclerosis. J Rheumatol. 2007.

  5. Wallberg-Jonsson S, Caidahl K, Klintland N, Nyberg G, Rantapaa-Dahlqvist S. Increased arterial stiffness and indication of endothelial dysfunction in long-standing rheumatoid arthritis. Scand J Rheumatol. 2008;37(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  6. Charles-Schoeman C, Watanabe J, Lee YY, Furst DE, Amjadi S, Elashoff D, et al. Abnormal function of high-density lipoprotein is associated with poor disease control and an altered protein cargo in rheumatoid arthritis. Arthritis Rheum. 2009;60(10):2870–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Watanabe J, Charles-Schoeman C, Miao Y, Elashoff D, Lee YY, Katselis G, et al. Proteomic profiling following immunoaffinity capture of high-density lipoprotein: association of acute-phase proteins and complement factors with proinflammatory high-density lipoprotein in rheumatoid arthritis. Arthritis Rheum. 2012;64(6):1828–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Charles-Schoeman C, Lee YY, Grijalva V, Amjadi S, FitzGerald J, Ranganath VK, et al. Cholesterol efflux by high density lipoproteins is impaired in patients with active rheumatoid arthritis. Ann Rheum Dis. 2012;71(7):1157–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Aubry MC, Maradit-Kremers H, Reinalda MS, Crowson CS, Edwards WD, Gabriel SE. Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis. J Rheumatol. 2007;34(5):937–42.

    CAS  PubMed  Google Scholar 

  10. Castaneda S, Nurmohamed MT, Gonzalez-Gay MA. Cardiovascular disease in inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol. 2016;30(5):851–69.

    Article  PubMed  Google Scholar 

  11. Libby P. Inflammation in atherosclerosis. Nature. 2002;420(6917):868–74.

    Article  CAS  PubMed  Google Scholar 

  12. Myasoedova E, Chandran A, Ilhan B, Major BT, Michet CJ, Matteson EL, et al. The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease. Ann Rheum Dis. 2015. Population-based cohort study reporting increased CVD risk from both flares and cumulative RA burden.

  13. • Solomon DH, Reed GW, Kremer JM, Curtis JR, Farkouh ME, Harrold LR, et al. Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis Rheumatol. 2015;67(6):1449–55. Longitudinal US cohort study reporting on the association of RA disease activity and CVD events.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. •• Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75(1):3–15. EULAR treat to target recommendations for RA.

    Article  PubMed  Google Scholar 

  15. • Markusse IM, Akdemir G, Dirven L, Goekoop-Ruiterman YP, van Groenendael JH, Han KH, et al. Long-term outcomes of patients with recent-onset rheumatoid arthritis after 10 years of tight controlled treatment: a randomized trial. Ann Intern Med. 2016;164(8):523–31. Randomized controlled trial results of a treat to target study in RA.

    Article  PubMed  Google Scholar 

  16. Solomon DH, Lee SB, Zak A, Corrigan C, Agosti J, Bitton A, et al. Implementation of treat-to-target in rheumatoid arthritis through a Learning Collaborative: Rationale and design of the TRACTION trial. Semin Arthritis Rheum. 2016;46(1):81–7.

    Article  PubMed  Google Scholar 

  17. Axelsen MB, Eshed I, Horslev-Petersen K, Stengaard-Pedersen K, Hetland ML, Moller J, et al. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis: results from the OPERA randomised controlled trial. Ann Rheum Dis. 2015;74(5):867–75.

    Article  CAS  PubMed  Google Scholar 

  18. • Avina-Zubieta JA, Abrahamowicz M, De Vera MA, Choi HK, Sayre EC, Rahman MM, et al. Immediate and past cumulative effects of oral glucocorticoids on the risk of acute myocardial infarction in rheumatoid arthritis: a population-based study. Rheumatology (Oxford). 2013;52(1):68–75. Population-based cohort study in Canada demonstrating correlation between current and cumulative steroid dosing in CVD risk.

    Article  CAS  Google Scholar 

  19. Ajeganova S, Svensson B, Hafstrom I. Low-dose prednisolone treatment of early rheumatoid arthritis and late cardiovascular outcome and survival: 10-year follow-up of a 2-year randomised trial. BMJ Open. 2014;4(4):e004259. e-publication.

    Article  PubMed  PubMed Central  Google Scholar 

  20. • del Rincon I, Battafarano DF, Restrepo JF, Erikson JM, Escalante A. Glucocorticoid dose thresholds associated with all-cause and cardiovascular mortality in rheumatoid arthritis. Arthritis Rheumatol. 2014;66(2):264–72. Clinic-based cohort study correlating glucocorticoid dose threshold of ≥8mg for increased cardiovascular and all cause mortality.

    Article  PubMed  Google Scholar 

  21. •• Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017. Updated EULAR CVD risk management recommendations in RA. Highlights include the recommendation to use a risk calculation modifier for all RA patients.

  22. Ray WA, Stein CM, Daugherty JR, Hall K, Arbogast PG, Griffin MR. COX-2 selective non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease. Lancet. 2002;360(9339):1071–3.

    Article  CAS  PubMed  Google Scholar 

  23. • Nissen SE, Yeomans ND, Solomon DH, Luscher TF, Libby P, Husni ME, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med. 2016;375(26):2519–29. Randomized double-blind non-inferiority study in RA and OA patients showing non-inferior risk for CVD events with celecoxib vs. ibuprofen and naproxen.

    Article  CAS  PubMed  Google Scholar 

  24. Sharma TS, Wasko MC, Tang X, Vedamurthy D, Yan X, Cote J, et al. Hydroxychloroquine use is associated with decreased incident cardiovascular events in rheumatoid arthritis patients. J Am Heart Assoc. 2016;5(1):e002867. e-publication.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Naranjo A, Sokka T, Descalzo MA, Calvo-Alen J, Horslev-Petersen K, Luukkainen RK, et al. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther. 2008;10(2):R30. e-publication.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Choi HK, Hernan MA, Seeger JD, Robins JM, Wolfe F. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet. 2002;359(9313):1173–7.

    Article  CAS  PubMed  Google Scholar 

  27. Vandhuick T, Allanore Y, Borderie D, Louvel JP, Fardellone P, Dieude P, et al. Early phase clinical and biological markers associated with subclinical atherosclerosis measured at 7 years of evolution in an early inflammatory arthritis cohort. Clin Exp Rheumatol. 2016;34(1):58–67.

    PubMed  Google Scholar 

  28. Kim HJ, Kim MJ, Lee CK, Hong YH. Effects of methotrexate on carotid intima-media thickness in patients with rheumatoid arthritis. J Korean Med Sci. 2015;30(11):1589–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Guin A, Chatterjee Adhikari M, Chakraborty S, Sinhamahapatra P, Ghosh A. Effects of disease modifying anti-rheumatic drugs on subclinical atherosclerosis and endothelial dysfunction which has been detected in early rheumatoid arthritis: 1-year follow-up study. Semin Arthritis Rheum. 2013;43(1):48–54.

    Article  CAS  PubMed  Google Scholar 

  30. Everett BM, Pradhan AD, Solomon DH, Paynter N, Macfadyen J, Zaharris E, et al. Rationale and design of the Cardiovascular Inflammation Reduction Trial: a test of the inflammatory hypothesis of atherothrombosis. Am Heart J. 2013;166(2):199–207. e15.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Solomon DH, Curtis JR, Saag KG, Lii J, Chen L, Harrold LR, et al. Cardiovascular risk in rheumatoid arthritis: comparing TNF-alpha blockade with nonbiologic DMARDs. Am J Med. 2013;126(8):730. e9- e17.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tam LS, Kitas GD, Gonzalez-Gay MA. Can suppression of inflammation by anti-TNF prevent progression of subclinical atherosclerosis in inflammatory arthritis? Rheumatology (Oxford). 2014;53(6):1108–19.

    Article  CAS  Google Scholar 

  33. Curtis JR, Perez-Gutthann S, Suissa S, Napalkov P, Singh N, Thompson L, et al. Tocilizumab in rheumatoid arthritis: a case study of safety evaluations of a large postmarketing data set from multiple data sources. Semin Arthritis Rheum. 2015;44(4):381–8.

    Article  CAS  PubMed  Google Scholar 

  34. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993;88(1):107–15.

    Article  CAS  PubMed  Google Scholar 

  35. Arts EE, Popa C, Den Broeder AA, Semb AG, Toms T, Kitas GD, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis. 2015;74(4):668–74.

    Article  CAS  PubMed  Google Scholar 

  36. Crowson CS, Matteson EL, Roger VL, Therneau TM, Gabriel SE. Usefulness of risk scores to estimate the risk of cardiovascular disease in patients with rheumatoid arthritis. Am J Cardiol. 2012;110(3):420–4.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ. 2008;336(7659):1475–82.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2009;69(2):325–31.

    Article  PubMed  Google Scholar 

  39. Arts EE, Popa CD, Den Broeder AA, Donders R, Sandoo A, Toms T, et al. Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms. Ann Rheum Dis. 2016;75(4):674–80.

    Article  CAS  PubMed  Google Scholar 

  40. Solomon DH, Greenberg J, Curtis JR, Liu M, Farkouh ME, Tsao P, et al. Derivation and internal validation of an expanded cardiovascular risk prediction score for rheumatoid arthritis: a Consortium of Rheumatology Researchers of North America Registry Study. Arthritis Rheumatol. 2015;67(8):1995–2003.

    Article  CAS  PubMed  Google Scholar 

  41. Jafri K, Bartels CM, Shin D, Gelfand JM, Ogdie A. Incidence and management of cardiovascular risk factors in psoriatic arthritis and rheumatoid arthritis: a population-based study. Arthritis Care Res (Hoboken). 2017;69(1):51–7.

    Article  Google Scholar 

  42. Bartels CM, Roberts TJ, Hansen KE, Jacobs EA, Gilmore A, Maxcy C, et al. Rheumatologist and primary care management of cardiovascular disease risk in rheumatoid arthritis: patient and provider perspectives. Arthritis Care Res (Hoboken). 2016;68(4):415–23.

    Article  Google Scholar 

  43. Burgos PI, Alarcon GS. Preventive health services for systemic lupus erythematosus patients: whose job is it? Arthritis Res Ther. 2010;12(3):124.

    Article  PubMed  PubMed Central  Google Scholar 

  44. • Barber CE, Marshall DA, Alvarez N, Mancini GB, Lacaille D, Keeling S, et al. Development of cardiovascular quality indicators for rheumatoid arthritis: results from an international expert panel using a novel online process. J Rheumatol. 2015;42(9):1548–55. International Delphi study recommending eleven cardiovascular quality indicators for RA.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Barber CE, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, et al. Gaps in addressing cardiovascular risk in rheumatoid arthritis: assessing performance using cardiovascular quality indicators. J Rheumatol. 2016;43(11):1965–73.

    Article  PubMed  Google Scholar 

  46. Chung CP, Giles JT, Petri M, Szklo M, Post W, Blumenthal RS, et al. Prevalence of traditional modifiable cardiovascular risk factors in patients with rheumatoid arthritis: comparison with control subjects from the multi-ethnic study of atherosclerosis. Semin Arthritis Rheum. 2012;41(4):535–44.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Desai SS, Myles JD, Kaplan MJ. Suboptimal cardiovascular risk factor identification and management in patients with rheumatoid arthritis: a cohort analysis. Arthritis Res Ther. 2012;14(6):R270. e-publication.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Panoulas VF, Douglas KM, Milionis HJ, Stavropoulos-Kalinglou A, Nightingale P, Kita MD, et al. Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology (Oxford). 2007;46(9):1477–82.

    Article  CAS  Google Scholar 

  49. •• Primdahl J, Clausen J, Horslev-Petersen K. Results from systematic screening for cardiovascular risk in outpatients with rheumatoid arthritis in accordance with the EULAR recommendations. Ann Rheum Dis. 2013;72(11):1771–6. Trial of comprehensive nurse CVD risk screening in RA. Nurse visits for CVD risk assessment identified many new risk factor diagnoses.

    Article  CAS  PubMed  Google Scholar 

  50. Primdahl J, Sorensen J, Horn HC, Petersen R, Horslev-Petersen K. Shared care or nursing consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with low disease activity--patient outcomes from a 2-year, randomised controlled trial. Ann Rheum Dis. 2013.

  51. Sorensen J, Primdahl J, Horn HC, Horslev-Petersen K. Shared care or nurse consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis (RA) outpatients with stable low disease-activity RA: cost-effectiveness based on a 2-year randomized trial. Scand J Rheumatol. 2015;44(1):13–21.

    Article  CAS  PubMed  Google Scholar 

  52. Kievit W, Maurits JS, Arts EE, van Riel PL, Fransen J, Popa CD. Cardiovascular screening in patients with Rheumatoid Arthritis is cost-effective. Arthritis Care Res (Hoboken). 2016.

  53. American Heart Association. American Heart Association Position Statement on State Efforts to Mandate Coronary Arterial Calcification and Carotid Intima Media Thickness Screenings Among Asymptomatic Adults. 2012. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_467574.pdf. Accessed January 11, 2017.

  54. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93–111; quiz 89–90.

  55. Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, et al. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2009;53(4):345–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Karpouzas GA, Malpeso J, Choi TY, Li D, Munoz S, Budoff MJ. Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. Ann Rheum Dis. 2014;73(10):1797–804.

    Article  PubMed  Google Scholar 

  57. Ikdahl E, Rollefstad S, Wibetoe G, Olsen IC, Berg IJ, Hisdal J, et al. Predictive value of arterial stiffness and subclinical carotid atherosclerosis for cardiovascular disease in patients with rheumatoid arthritis. J Rheumatol. 2016;43(9):1622–30.

    Article  PubMed  Google Scholar 

  58. • Semb AG, Rollefstad S, van Riel P, Kitas GD, Matteson EL, Gabriel SE. Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice. Ann Rheum Dis. 2014;73(7):1284–8. International expert recommendations on CVD risk assessment in RA.

    Article  PubMed  Google Scholar 

  59. Lucke M, Messner W, Kim ES, Husni ME. The impact of identifying carotid plaque on addressing cardiovascular risk in psoriatic arthritis. Arthritis Res Ther. 2016;18:178.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Rose GA. The strategy of preventive medicine. Oxford: Oxford University Press; 1992.

    Google Scholar 

  61. • Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. JAMA. 2013;310(7):699–705. Large pragmatic trial of primary care hypertension protocols that improved population blood pressure control at a large HMO.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. CDC. Vital signs: awareness and treatment of uncontrolled hypertension among adults--United States, 2003–2010. Morb Mortal Wkly Rep. 2012;61:703–9.

    Google Scholar 

  63. Frieden TR, King SM, Wright JS. Protocol-based treatment of hypertension: a critical step on the pathway to progress. JAMA. 2014;311(1):21–2.

    Article  CAS  PubMed  Google Scholar 

  64. Ogden LG, He J, Lydick E, Whelton PK. Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension. 2000;35(2):539–43.

    Article  CAS  PubMed  Google Scholar 

  65. • James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. Controversial updated hypertension management guidelines from 2014 (JNC 8).

    Article  CAS  PubMed  Google Scholar 

  66. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens. 2014;32(1):3–15.

    Article  CAS  PubMed  Google Scholar 

  67. Midtbo H, Gerdts E, Kvien TK, Olsen IC, Lonnebakken MT, Davidsen ES, et al. The association of hypertension with asymptomatic cardiovascular organ damage in rheumatoid arthritis. Blood Press. 2016;25(5):298–304.

    Article  PubMed  Google Scholar 

  68. Bartels CM, Johnson H, Voelker K, Thorpe C, McBride P, Jacobs EA, et al. Impact of rheumatoid arthritis on receiving a diagnosis of hypertension among patients with regular primary care. Arthritis Care Res (Hoboken). 2014;66(9):1281–8.

    Article  Google Scholar 

  69. An J, Cheetham TC, Reynolds K, Alemao E, Kawabata H, Liao KP, et al. Traditional cardiovascular risk factor management in rheumatoid arthritis compared to matched nonrheumatoid arthritis in a US managed care setting. Arthritis Care Res (Hoboken). 2016;68(5):629–37.

    Article  CAS  Google Scholar 

  70. Bartels C, Ramly E, Johnson H, P M, Li Z, Zhao Y, et al. Improving Timely Follow-up After High Blood Pressures in Rheumatology Clinics Using Staff Protocols [Abstract]. European League Against Rheumatism (EULAR) Congress. London, UK: Ann Rheum Dis; 2016. p. 877.

  71. Bartels C, Ramly E, Johnson H, Zhao Y, Lewicki K, Lauver DR. Improved Follow-up of Hypertension in Rheumatology Patients: Results of a Pilot [Abstract]. Arthritis Rheum. 2015;67(10).

  72. Karlson EW, Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. A retrospective cohort study of cigarette smoking and risk of rheumatoid arthritis in female health professionals. Arthritis Rheum. 1999;42(5):910–7.

    Article  CAS  PubMed  Google Scholar 

  73. Navarro-Millán I, Charles-Schoeman C, Yang S, Bathon JM, Bridges SL, Chen L, et al. Changes in lipoproteins associated with methotrexate therapy or combination therapy in early rheumatoid arthritis: results from the treatment of early rheumatoid arthritis trial. Arthritis Rheumatism. 2013;65(6):1430–8.

    Article  PubMed  PubMed Central  Google Scholar 

  74. • Saevarsdottir S, Rezaei H, Geborek P, Petersson I, Ernestam S, Albertsson K, et al. Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial. Ann Rheum Dis. 2015;74(8):1509–14. Secondary analysis comparing smoking and non-smoking RA patients from a randomized non-blinded parallel treatment study.

    Article  PubMed  Google Scholar 

  75. Abhishek A, Butt S, Gadsby K, Zhang W, Deighton CM. Anti-TNF-alpha agents are less effective for the treatment of rheumatoid arthritis in current smokers. J Clin Rheumatol. 2010;16(1):15–8.

    Article  CAS  PubMed  Google Scholar 

  76. Saevarsdottir S, Wedren S, Seddighzadeh M, Bengtsson C, Wesley A, Lindblad S, et al. Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts. Arthritis Rheum. 2011;63(1):26–36.

    Article  CAS  PubMed  Google Scholar 

  77. Soderlin MK, Petersson IF, Geborek P. The effect of smoking on response and drug survival in rheumatoid arthritis patients treated with their first anti-TNF drug. Scand J Rheumatol. 2012;41(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  78. Hyrich KL, Watson KD, Silman AJ, Symmons DP. Predictors of response to anti-TNF-alpha therapy among patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford). 2006;45(12):1558–65.

    Article  CAS  Google Scholar 

  79. Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database Syst Rev. 2011;12:CD008743.

    Google Scholar 

  80. Carson KV, Verbiest ME, Crone MR, Brinn MP, Esterman AJ, Assendelft WJ, et al. Training health professionals in smoking cessation. Cochrane Database Syst Rev. 2012;5:CD000214.

    Google Scholar 

  81. • Vidrine JI, Shete S, Cao Y, Greisinger A, Harmonson P, Sharp B, et al. Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings. JAMA Intern Med. 2013;173(6):458–64. Cluster randomized trial that demonstrated than an ask-advise-connect vs an ask-advise-refer strategy resulted in 13 times more tobacco quit line utilization.

    Article  PubMed  Google Scholar 

  82. Siu AL. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2015;163(8):622–34.

    Article  PubMed  Google Scholar 

  83. Fiore MC, Jaen CR. A clinical blueprint to accelerate the elimination of tobacco use. JAMA. 2008;299(17):2083–5.

    Article  CAS  PubMed  Google Scholar 

  84. Naranjo A, Khan NA, Cutolo M, Lee SS, Lazovskis J, Laas K, et al. Smoking cessation advice by rheumatologists: results of an international survey. Rheumatology (Oxford). 2014;53(10):1825–9.

    Article  Google Scholar 

  85. Naranjo A, Bilbao A, Erausquin C, Ojeda S, Francisco FM, Rua-Figueroa I, et al. Results of a specific smoking cessation program for patients with arthritis in a rheumatology clinic. Rheumatol Int. 2014;34(1):93–9.

    Article  PubMed  Google Scholar 

  86. • Baker TB, Piper ME, Stein JH, Smith SS, Bolt DM, Fraser DL, et al. Effects of nicotine patch vs varenicline vs combination nicotine replacement therapy on smoking cessation at 26 weeks: a randomized clinical trial. JAMA. 2016;315(4):371–9. Randomized controlled trial reporting equivalence between nicotine replacement therapy and varenicline for smoking cessation.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Mackey RH, Kuller LH, Moreland LW. Cardiovascular disease risk in patients with rheumatic diseases. Clin Geriatr Med. 2017;33(1):105–17.

    Article  PubMed  Google Scholar 

  88. Genest J, McPherson R, Frohlich J, Anderson T, Campbell N, Carpentier A, et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult - 2009 recommendations. Can J Cardiol. 2009;25(10):567–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Bartels CM, Kind AJ, Everett C, Mell M, McBride P, Smith M. Low frequency of primary lipid screening among medicare patients with rheumatoid arthritis. Arthritis Rheum. 2011;63(5):1221–30.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Bartels CM, Kind AJ, Thorpe CT, Everett CM, Cook RJ, McBride PE, et al. Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities: a medicare analysis. Semin Arthritis Rheum. 2012;42(1):9–16.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Danninger K, Hoppe UC, Pieringer H. Do statins reduce the cardiovascular risk in patients with rheumatoid arthritis? Int J Rheum Dis. 2014;17(6):606–11.

    Article  CAS  PubMed  Google Scholar 

  92. De Vera MA, Choi H, Abrahamowicz M, Kopec J, Goycochea-Robles MV, Lacaille D. Statin discontinuation and risk of acute myocardial infarction in patients with rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis. 2011;70(6):1020–4.

    Article  PubMed  Google Scholar 

  93. McInnes IB, Kim HY, Lee SH, Mandel D, Song YW, Connell CA, et al. Open-label tofacitinib and double-blind atorvastatin in rheumatoid arthritis patients: a randomised study. Ann Rheum Dis. 2014;73(1):124–31.

    Article  CAS  PubMed  Google Scholar 

  94. De Vera MA, Choi H, Abrahamowicz M, Kopec J, Lacaille D. Impact of statin discontinuation on mortality in patients with rheumatoid arthritis: a population-based study. Arthritis Care Res (Hoboken). 2012;64(6):809–16.

    Article  Google Scholar 

  95. Ikdahl E, Rollefstad S, Hisdal J, Olsen IC, Pedersen TR, Kvien TK, et al. Sustained improvement of arterial stiffness and blood pressure after long-term rosuvastatin treatment in patients with inflammatory joint diseases: results from the RORA-AS study. PLoS One. 2016;11(4):e0153440. e-publication.

    Article  PubMed  PubMed Central  Google Scholar 

  96. • Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline 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. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934. 2013 ACC/AHA guidelines for adult lipid management.

    Article  PubMed  Google Scholar 

  97. Micromedex. Tofacitinib: Monitoring. Greenwood Village, CO: Truven Health Analytics; 2017. Available at: www.micromedex.com/pharmaceutical. Accessed January 1, 2017.

  98. Micromedex. Tocilizumab: Monitoring. Greenwood Village, CO: Truven Health Analytics; 2017. Available at: www.micromedex.com/pharmaceutical. Accessed January 1, 2017.

  99. Schroeder LL, Tang X, Wasko MC, Bili A. Glucocorticoid use is associated with increase in HDL and no change in other lipids in rheumatoid arthritis patients. Rheumatol Int. 2015;35(6):1059–67.

    Article  CAS  PubMed  Google Scholar 

  100. Charles-Schoeman C, Yin Lee Y, Shahbazian A, Wang X, Elashoff D, Curtis JR, et al. Improvement of high-density lipoprotein function in patients with early rheumatoid arthritis treated with methotrexate monotherapy or combination therapies in a randomized controlled trial. Arthritis Rheumatol. 2017;69(1):46–57.

    Article  CAS  PubMed  Google Scholar 

  101. Bartels CM, Wong J, Johnson H, Voelker K, Smith M. Predictors of cholesterol and lifestyle discussions in rheumatoid arthritis visits: impact of perceived ra control and comparison with other prevention topics [Abstract]. Arthritis Rheum. 2014. p. S511.

  102. Verhoeven F, Tordi N, Prati C, Demougeot C, Mougin F, Wendling D. Physical activity in patients with rheumatoid arthritis. Joint Bone Spine. 2016;83(3):265–70.

    Article  PubMed  Google Scholar 

  103. Stavropoulos-Kalinoglou A, Metsios GS, Veldhuijzen van Zanten JJ, Nightingale P, Kitas GD, Koutedakis Y. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2013;72(11):1819–25.

    Article  CAS  PubMed  Google Scholar 

  104. Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum. 2009;61(12):1726–34.

    Article  PubMed  Google Scholar 

  105. Sandberg ME, Wedren S, Klareskog L, Lundberg IE, Opava CH, Alfredsson L, et al. Patients with regular physical activity before onset of rheumatoid arthritis present with milder disease. Ann Rheum Dis. 2014;73(8):1541–4.

    Article  PubMed  Google Scholar 

  106. • Petersson IF, Strombeck B, Andersen L, Cimmino M, Greiff R, Loza E, et al. Development of healthcare quality indicators for rheumatoid arthritis in Europe: the eumusc.net project. Ann Rheum Dis. 2014;73(5):906–8. European expert panel recommendations for RA care quality, which include providing exercise recommendations.

    Article  PubMed  Google Scholar 

  107. • Centers for Disease Control and Prevention. Physical Activity Programs. 2016. Available at: https://www.cdc.gov/arthritis/interventions/physical-activity.html. Accessed January 11, 2017. CDC recommendation overview for physical activity in arthritis care. This includes five endorsed physical activity programs.

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Authors and Affiliations

  1. Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Ann M. Chodara

  2. Rheumatology Division, Department of Medicine, University of Wisconsin (UW) School of Medicine and Public Health (SMPH), 1685 Highland Ave, Rm 4132, 53705-2281, Madison, WI, USA

    Aimée Wattiaux & Christie M. Bartels

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  1. Ann M. Chodara
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  2. Aimée Wattiaux
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  3. Christie M. Bartels
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Correspondence to Christie M. Bartels.

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Bartels receives peer-reviewed grant funding from Independent Grants for Learning and Change, Pfizer. Aimée Wattiaux and Ann Chodara declare that they have no conflict of interest.

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This article does not contain any previously unreported studies with human and animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Rheumatoid Arthritis

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Chodara, A.M., Wattiaux, A. & Bartels, C.M. Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches. Curr Rheumatol Rep 19, 16 (2017). https://doi.org/10.1007/s11926-017-0643-y

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