Italian recommendations for the assessment of cardiovascular risk in rheumatoid arthritis: a position paper of the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group of the Italian Society of Rheumatology
F. Cacciapaglia1, F.R. Spinelli2, G.L. Erre3, E. Gremese4, A. Manfredi5, M. Piga6, G. Sakellariou7, O. Viapiana8, F. Atzeni9, E. Bartoloni10
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DePReMeI), Università degli Studi di Bari, Italy. firstname.lastname@example.org
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Roma La Sapienza, Rome, Italy.
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Italy.
- Department of Geriatrics, Orthopaedics, and Rheumatology, Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
- Rheumatology Unit, Azienda Ospedaliera Universitaria Policlinico of Modena, Italy.
- Rheumatology Unit, AOU Cagliari, and Department of Medical Sciences and Public Health, University of Cagliari, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia; and Istituti Clinici Scientifici Maugeri, Pavia, Italy.
- Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy.
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Italy.
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy.
PMID: 36912349 [PubMed]
Accepted : 16/12/2022
In Press: 02/03/2023
Rheumatoid arthritis (RA) patients are at high risk of cardiovascular (CV) events. The aim of this position paper is to provide Italian rheumatologists with an easy, feasible and time-saving CV risk assessment in their daily clinical practice.
A narrative review of the literature and an assessment of the methodological strength underlying the current evidence on CV risk assessment in patients with RA were performed. The evidence-based results were shared among the members of the steering committee of the CORDIS study group of the Italian Society of Rheumatology. Subsequently, a unanimously agreed-upon algorithm was discussed and finally approved by the experts.
RA patients should have their CV profile monitored using the Italian ‘Progetto Cuore’ chart, according to the current EULAR recommendations for CV risk management, at least every 5 years. In the presence of high disease activity, or a multi-drug failure condition, when prolonged treatment with glucocorticoids and/or NSAIDs is required, or if hypertension, dyslipidaemia, or diabetes mellitus are concomitant, a more stringent CV risk assessment should be considered. When moderate CV risk is documented, patients should undergo intima-media thickening measurement. The condition of high CV risk requires a cardiological evaluation.
This position paper provides five Italian recommendations for CV risk assessment in RA patients. A general and uniform approach to CV risk profiling may be useful to identify those patients who should undertake intensive preventive strategies to improve their CV outcomes.