Management of CVD risk in patients with immune-mediated inflammatory diseases: Practice Guidelines
Netherlands: A recent guideline published in the BMJ journal Heart focuses on the management of cardiovascular disease (CVD) risk in immune-mediated inflammatory diseases.
Immune-mediated inflammatory diseases (IMIDs) comprise a wide range of conditions of which rheumatoid arthritis (RA), spondyloarthritis (SpA) and inflammatory bowel disease (IBD; ie, Crohn's disease and ulcerative colitis) are most common. SpA consists of a range of diseases, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis, spondylitis associated with IBD and undifferentiated SpA.
As data regarding cardiovascular disease (CVD) risk are mainly available for RA, AS, PsA, severe psoriasis and IBD, Rabia Agca, Rheumatology, Amsterdam UMC and Reade, Amsterdam, Noord-Holland, Netherlands, and colleagues focused on these conditions.
Key recommendations include:
- Optimal anti-inflammatory treatment is necessary to reduce cardiovascular disease (CVD) risk in immune-mediated inflammatory diseases (IMIDs).
- Lifestyle interventions according to national guidelines, such as smoking cessation, exercise to increase physical fitness and lean body mass, and healthy diets, are recommended.
- Optimal treatment of CVD risk factors, including dyslipidaemia and hypertension, according to existing national guidelines is as important as lowering inflammation to reduce CVD risk in IMIDs.
- Treatment targets for lowering low-density lipoprotein and blood pressure should be according to national guidelines.
- Statins are as effective in lowering lipid levels in patients with IMIDs as in the general population.
- Patients with IMIDs should be screened for diabetes.
- For rheumatoid arthritis a multiplication factor should be applied to CVD risk prediction algorithms.
- For other IMIDs a risk assessment according to existing algorithms is recommended as there is insufficient evidence about other methods.
"IMIDs are associated with an increased CVD risk, which translates in increased healthcare cost and loss of quality of life in affected patients. This increased CVD risk is caused by a combination of an increased prevalence of traditional CVD risk factors and inflammation. Risk reduction is possible through early and effective management of CVD risk factors and optimal anti-inflammatory therapy aiming at—at least—low disease activity, but preferably disease remission," wrote the authors.
"There is a need for a multidisciplinary effort to reduce CVD risk in these patients. Healthcare professionals, especially rheumatologists, cardiologists and general practitioners, but also patients themselves should be aware of this increased CVD risk and take timely precautions. There lies an evidence gap which needs to be filled in the future, and general practice guidelines need to be developed to reduce CVD risk in these patients," they concluded.
The guideline titled, "Cardiovascular disease risk in immune-mediated inflammatory diseases: recommendations for clinical practice," is published in the BMJ journal Heart.
DOI: https://heart.bmj.com/content/early/2021/03/03/heartjnl-2019-316378
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