Cardiovascular morbidity associated with inflammatory rheumatic diseases

The excess risk

Several rheumatic diseases (particularly RA, SLE, and psoriatic arthritis) carry independently elevated cardiovascular risk beyond that explained by conventional risk factors alone - driven by the chronic systemic inflammation intrinsic to these conditions
Cardiovascular disease is a leading cause of excess mortality in RA and SLE, with risk elevation comparable in magnitude to diabetes mellitus - a frequently under-recognised aspect of these conditions' overall disease burden

Chronic systemic inflammation (elevated TNF-alpha, IL-6, CRP) directly accelerates atherosclerosis - promoting endothelial dysfunction, pro-atherogenic lipid changes, and plaque instability - independent of, and additive to, conventional risk factors (smoking, hypertension, dyslipidaemia)

Standard cardiovascular risk calculators underestimate true risk in these populations since they do not incorporate the inflammatory disease burden itself - some guidelines recommend a risk-multiplier adjustment (e.g. for RA) when using standard risk tools
Regular cardiovascular risk assessment should be incorporated into routine rheumatic disease follow-up, not treated as a separate, lower-priority concern from joint disease management

Effective control of the underlying inflammatory disease itself reduces cardiovascular risk (an important, sometimes underappreciated rationale for aggressive disease-modifying treatment beyond joint symptom control alone)
Conventional cardiovascular risk factor modification (statins, BP control, smoking cessation) should be pursued with the same or greater intensity as in a standard higher-risk population, given the compounding inflammatory risk
Some disease-modifying drugs (e.g. certain NSAIDs, and historically some COX-2 inhibitors) carry their own cardiovascular risk considerations, requiring individualised weighing alongside disease control benefit

Rheumatoid arthritis, SLE, psoriatic arthritis, accelerated atherosclerosis, statin therapy in inflammatory disease

Cardiovascular risk in inflammatory rheumatic disease should be actively and routinely assessed and managed as a core part of rheumatological care, not treated as an incidental comorbidity to be addressed only if it happens to be noticed - the excess mortality risk is substantial and, importantly, at least partly modifiable through both disease control and standard risk factor management

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