In people suffering from inflammatory diseases the risks

I’ve read that the risk of cardiovascular problems is higher for people with arthritis. It bothers me. What is my risk level and what tests should I undergo?

He answers Charles SelmiHead of Rheumatology and Clinical Immunology, Humanitas Institute, Milan (GO TO THE FORUM)

It is very clear today how chronic infection be a cause of acceleration atherosclerosis through common immunological mechanisms, well represented by some cytokines such as IL6, thus influencing the cardiovascular riskor the risk of acute disease of the coronary arteries or of the cerebral circulation (particularly stroke). In recent years, numerous studies have shown that, even in those who do not suffer from an inflammatory disease, chronic inflammation is the basis of the changes of the arteries responsible for heart and cerebrovascular disease. In the field of immunology, a recent study from Cleveland (USA) has been published in the Journal of the American Heart Association examined more than 60,000 patients with chronic inflammatory diseases and showed how cases of myocardial infarction occurred more often and at a younger age compared to the rest of the population. The same study observed that people with chronic inflammatory disease are at greater risk of heart failure, a chronic condition in which the heart cannot guarantee an insufficient pumping action, causing breathing difficulties and edema in the lower extremities with minor exertion.

In the case of rheumatoid arthritis, this increases cardiovascular risk by 50%, regardless of other individual characteristics. It is therefore of great importance in patients with the disease check for other conditions that may increase your risk, especially stop smoking, avoid obesity and overweight, maintain an active lifestyle and check the levels cholesterol and triglycerides
. It should be emphasized that cigarette smoking is not only involved in the onset of rheumatoid arthritis, but is also linked to a more aggressive and less responsive disease. However, the cardiovascular risk associated with rheumatoid arthritis can be reduced to values ​​for the general population consistent with age, sex, and other risk factors when the disease is in remissiona goal that can be achieved today mainly by combining classic medicines such as methotrexate with molecules of more recent use directed against inflammatory mediators, to be taken both biologically and subcutaneously (ie monoclonal antibodies o soluble receptors against IL6, TNFalpha, CTLA4) o oral small molecules against JACK. On the other hand, the choice of these drugs should also be taken into account the cardiological profile of the individualas some mechanisms need to be used more cautiously under certain circumstances.

For example TNFalfa biologics are contraindicated in people suffering from heart failure. This was recently ordered by the European Medicines Agency (EMA). anti-JAK drugs should be introduced with caution in those with individual characteristics (age, hypercholesterolemia, arterial hypertension, cigarette smoking) that increase cardiovascular risk, even though the data on most of these molecules seem reassuring. Based on this recent indication the issue was raised of patients who have been on anti-JAK therapy for some time and are in remission of rheumatological disease. To date, there is no indication of the choice to be made in these cases and it is therefore necessary to evaluate and discuss with the patient the opposing risks of cardiac side effects and reactivation of the disease in case of a change in therapy.