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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ERheumatic diseases are associated with a known risk of premature cardiovascular disease. This article not only discusses best practices, but also the prevention and management of cardiovascular risk in patients with inflammatory disorders.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Erheumatoid arthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einflammatory disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elupus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erheumatological autoimmune disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ERheumatic diseases are associated with a known risk of premature cardiovascular disease (CVD). This Best Practice Session was devoted to the prevention and management of cardiovascular (CV) risk in patients with inflammatory disorders.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESLE Patients\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIan Bruce, MD, FRCP, University of Manchester, Manchester, UK, presented data that outlined the risk factors for coronary heart disease (CHD) in SLE patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ESLE patients aged \u0026lt;55 years have been shown to have significantly more carotid plaque (21% vs 3%; p\u0026lt;0.01) compared with control subjects [Ahmad Y et al. \u003Cem\u003ERheumatology\u003C\/em\u003E 2007]. This may be related to the inflammatory mechanisms that are central to SLE, such as the interferon-1 and complement pathways that appear to be important factors in atherogenesis. In addition, low TGF-\u03b2 1 activation that is seen in SLE patients is linked to increased lymphocyte apoptosis, irreversible organ damage, disease duration, calculated low-density lipoprotein levels, and increased carotid intima-media thickness (IMT) and therefore may also aid in the promotion of early atherosclerosis [Jackson M et al. \u003Cem\u003EArthritis Res Ther\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EWhen hypertension and diabetes mellitus, also more prevalent in SLE patients, are accounted for, SLE remains independently associated with an increased risk for CHD. Persistent hypercholesterolemia, found in 34% to 51% of patients with SLE, also appears to be an independent risk factor.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDr. Bruce discussed measures to reduce CV risk, such as the use of the anti-malarial hydroxychloroquine to treat the pain and swelling of arthritis. He noted that low-dose steroids have a beneficial anti-inflammatory effect, although high doses may be detrimental because they exacerbate metabolic risk factors. Dr. Bruce suggested screening SLE patients for CHD, minimizing both inflammatory disease activity and overall steroid exposure, and using hydroxychloroquine and low-dose aspirin judiciously.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERheumatoid Arthritis (RA) Patients\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAlexandre Voskuyl, MD, PhD, VU University Medical Center, Amsterdam, The Netherlands, presented current data that concern the management of CV complications in RA patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ERA patients have more than twice the risk for congestive heart failure, ischemic heart disease, myocardial infarction, and peripheral vascular disease compared with the general population. In addition to the classic risk factors (uncontrolled hypertension, dyslipidemia, and diabetes), specific risk factors for CVD-related mortality, morbidity, or subclinical atherosclerosis in RA patients include consistent inflammation, disease duration, higher ESR, extra-articular features, and rheumatoid factor. Joint damage has been shown to be associated with increased IMT, a surrogate marker of CVD.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIn patients with RA, disease-modifying antirheumatic drugs (DMARDs), in particular methotrexate, and biologics may reduce CV risk by reducing inflammatory pathways that are important in the development of atherosclerosis and by reducing the effect of other CVD risk factors (eg, improving atherogenic lipid profile, improving physical fitness, and improving insulin resistance).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EAs a management strategy, Associate Prof. Voskuyl suggests screening RA patients for CVD risk factors, treating hypertension and dyslipidemia according to current guidelines, and using anti-platelet therapy when appropriate. Consideration also should be given to reducing disease activity more profoundly with (change of) DMARDs and biologics.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESystemic Sclerosis (SSc) Patients\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EMyocardial involvement due to microcirculation impairment is frequent in the majority of SSc patients. Andre Kahan, MD, H\u00f4pital Cochin, Paris, France, reported on several studies that showed that calcium channel inhibitors (nifedipine and nicardipine), ACE inhibitors (captopril), and the endothelin receptor antagonist bosentan may be useful treatments to improve myocardial perfusion and metabolism, and left and right ventricular functions in SSc patients [Vignaux O et al. \u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2005; Allanore Y et al. \u003Cem\u003EJ Rheumatol\u003C\/em\u003E 2006; Meune C et al. \u003Cem\u003EJ Rheumatol\u003C\/em\u003E 2004] (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/5\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Left Ventricular Ejection Fraction in SSc.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1892568445\u0022 data-figure-caption=\u0022Left Ventricular Ejection Fraction in SSc.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/5\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/5\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/5\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10968\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ELeft Ventricular Ejection Fraction in SSc.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERA Resembles Type 2 Diabetes as Risk Factor for CVD\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EMike Peters, MD, VU University Medical Center, Amsterdam, The Netherlands, presented data from the CARR\u00c9 study, which compared the prevalence of CVD in RA patients with normal fasting glucose levels with the prevalence of CVD in patients from the Hoorn Study\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003E[Dekker JM et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2005] who had either normal fasting glucose levels or type 2 diabetes. The prevalence of CVD was 9.7% (95% CI, 6.0% to 13.4%) in Hoorn study subjects with normal glucose levels and 21.6% (95% CI, 15.7% to 27.5%) in those with type 2 diabetes versus 15.7% (95% CI, 11.4% to 20.0%) in RA subjects with normal glucose levels. No significant difference in prevalence was observed between RA patients with normal glucose levels and those with type 2 diabetes, suggesting a similar CVD risk in the 2 diseases.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-6\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERA is an Important Independent Risk Factor for Incident CVD\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EIn another study that was presented by Prof. Peters, RA was shown to be an independent, significant (p\u22640.01) risk factor for CVD compared with the general population. Data from CARR\u00c9 that analyzed the 3-year incidence of CVD in 363 RA patients noted at least 1 CV event in 8.6% of the RA patients versus in 4.3% of the general population, corresponding with an incidence of 3.14\/100 patient-years (95% CI, 1.98\u20134.30) for RA patients and 1.51\/100 patient-years (95% CI, 1.18\u20131.84) for the general population. Even after adjustment for a higher prevalence of traditional CV risk factors that normally are found in RA patients, the CVD risk in patients with RA remains significantly elevated compared with the general population.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-7\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECV Risk Among Patients with RA in CORRONA\u003C\/h2\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EDaniel Solomon, MD, Brigham and Women\u0027s Hospital, Boston, MA, presented data from the CORRONA registry, which contains data on over 14,000 RA patients. The study compared CV risk factors (CVRFs) with RA disease factors (RADFs) with the goal of developing more robust clinical prediction rules for cardiovascular outcomes. CVRFs included a history of coronary artery disease or myocardial infarction (MI), diabetes, hypertension, family history of premature MI, low body mass index (BMI), dyslipidemia (assessed as use of a lipid-lowering agent), race, and current tobacco use. RADFs included duration of RA, RF status, HAQ, clinical disease activity index (CDAI), subcutaneous nodules, Sj\u00f6grens, tender joint count, swollen joint count, and total joint replacements. In multivariable Cox regression models, the CVRFs with increased relative risks (RR) included race (RR 1.26), low BMI (RR 1.25), prior MI (RR 1.75), and tobacco use (RR 1.92). The RADFs with increased RRs were subcutaneous nodules (RR 1.44), HAQ-DI (RR 1.20), and the CDAI (RR 1.06). Overall c-statistic was 0.80, suggesting that CVRFs and RADFs share similar explanatory value in explaining CV endpoints.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/5\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmeg1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmeg1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}