Treat-to-target approach for CVD risk factors decreased atherosclerosis in RA patients

It is well recognized that traditional cardiovascular disease (CVD) risk factors contribute to atherogenesis and CVD events in rheumatoid arthritis (RA) patients at least as much as inflammatory risk factors, and traditional risk factors and inflammatory risk factors may interact (i.e. inflammatory risk factors have a greater impact in the setting of higher number of traditional risk factors).

Many rheumatologists concentrate on reducing inflammation, but may not focus on the traditional risk factors, or leave these to be managed by primary care physicians. The study by Burggraaf et al. reminds us that addressing the traditional risk factors is also important since most of the patients in the study had low disease activity at baseline and maintained it throughout the study, yet there was a suggestion that atherosclerosis progression was improved when lipid-lowering drugs and antihypertensives were more aggressively used. It may increase awareness of the importance of measuring and controlling traditional risk factors and not relying on other providers to recognize that there is heightened risk in this population.

There is documented reluctance among many rheumatologists to take on the additional burden of screening and managing hyperlipidemia, hypertension, diabetes, weight management, diet, and so on in addition to all the other aspects of managing these patients that take a lot of time. Research is needed on how to efficiently streamline measurement and management of CVD risk in these patients to optimize outcomes.

Jon T. Giles, MD , is a rheumatologist in the division of rheumatology at Columbia University in New York. He was not involved in the study by Burggraaf et al. and reported no relevant conflicts of interest.