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Cardiovascular Disease Risk in Older Adults and Elderly Patients with Rheumatoid Arthritis: What Role Can Disease-Modifying Antirheumatic Drugs Play in Cardiovascular Risk Reduction?

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Abstract

The prevalence of rheumatoid arthritis (RA), the most common autoimmune inflammatory arthritis, is increasing, partly due to the aging of the general population. RA is an independent risk factor for the development of cardiovascular disease (CVD). Older adults and elderly patients with RA develop CVD at a younger age compared with their general population peers. Both the traditional cardiovascular risk factors (age, sex, smoking, diabetes mellitus, hypertension), and systemic inflammation (i.e. high disease activity) are contributors to accelerated CVD in people with RA. Of the disease-modifying antirheumatic drugs (DMARDs) used for RA treatment, methotrexate, triple combination oral therapy (methotrexate, sulfasalazine, and hydroxychloroquine), tumor necrosis factor inhibitor biologicals, and abatacept have the strongest data in favor of the reduction of cardiovascular events in patients with RA. A treat-to-target strategy should be employed in older adults and elderly patients with RA to ensure appropriate reduction in cardiovascular risk, which can also prevent short- and long-term musculoskeletal disability. Our review findings are in line with the 2016 European League Against Rheumatism guideline recommendations, specifically: (1) RA disease activity should be controlled with an optimal DMARD regimen using a treat-to-target approach; (2) the lipid profile should be assessed and monitored in every older adult and elderly RA patient; (3) CVD risk factors, including smoking cessation, blood pressure, and blood glucose control, should be optimized; (4) RA treatment should be initiated as soon as possible; and (5) shared decision making regarding the treatment of patients with RA should include a discussion on the potential amelioration of increased cardiovascular risk.

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Authors and Affiliations

  1. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA

    Alvin Lee Day & Jasvinder A. Singh

  2. Medicine Service, VA Medical Center, 510, 20th Street South, FOT 805B, Birmingham, AL, USA

    Jasvinder A. Singh

  3. Department of Epidemiology at the UAB School of Public Health, 1665 University Blvd, Ryals Public Health Building, Room 220, Birmingham, AL, 35294-0022, USA

    Jasvinder A. Singh

  4. University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA

    Jasvinder A. Singh

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Alvin Lee Day has no conflicts of interest to declare. Jasvinder A. Singh has received research grants from Takeda and Savient pharmaceutical companies, and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon, Allergan and Fidia pharmaceutical companies, WebMD, UBM LLC, Medscape, the National Institutes of Health, and the American College of Rheumatology. He is also a member of the Veterans Affairs Rheumatology Field Advisory Committee, and is the Editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-Analysis. Furthermore, he has served as a member of the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees, Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee, and Co-Chair of the ACR Criteria and Response Criteria subcommittee, and is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies.

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Day, A.L., Singh, J.A. Cardiovascular Disease Risk in Older Adults and Elderly Patients with Rheumatoid Arthritis: What Role Can Disease-Modifying Antirheumatic Drugs Play in Cardiovascular Risk Reduction?. Drugs Aging 36, 493–510 (2019). https://doi.org/10.1007/s40266-019-00653-0

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