Cardiovascular morbidity in inflammatory rheumatic diseases
How much RA, SLE, spondyloarthritis, gout and vasculitis raise cardiovascular risk, why risk calculators underestimate it, the lipid paradox, EULAR advice (1.5 multiplier in RA, BP under 130/80 in SLE, drug choices) applied to the 2023 Australian calculator, and drug effects from glucocorticoids to JAK inhibitors.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Chronic inflammation accelerates atherosclerosis. RA carries about 1.5 to 2 times the cardiovascular risk of the general population, similar to type 2 diabetes. SLE risk is higher again, worst in young women.
- Standard calculators, including the 2023 Aus CVD Risk Calculator, don't include inflammatory disease as an input or reclassification factor. Risk is underestimated.
- Management is the same as for anyone (smoking, BP, lipids, glucose) plus tight disease control and the least glucocorticoid and NSAID possible.
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Sources
- Drosos GC et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis 2022;81:768-79EULAR, 2022 (latest for these diseases when checked November 2026)
- Agca R et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2017;76:17-28EULAR, 2015/2016 update (latest for RA, PsA and axSpA when checked November 2026)
- Australian guideline for assessing and managing cardiovascular disease risk, and Aus CVD Risk CalculatorAU/NZAustralian Chronic Disease Prevention Alliance, Heart Foundation and Department of Health, 2023 (current November 2026)
- Ytterberg SR et al. Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis (ORAL Surveillance). N Engl J Med 2022;386:316-26New England Journal of Medicine, 2022
- Kitas GD et al. Trial of atorvastatin for the primary prevention of cardiovascular events in patients with rheumatoid arthritis (TRACE RA). Arthritis Rheumatol 2019;71:1437-49Arthritis and Rheumatology, 2019
- Giles JT et al. Cardiovascular safety of tocilizumab versus etanercept in rheumatoid arthritis (ENTRACTE). Arthritis Rheumatol 2020;72:31-40Arthritis and Rheumatology, 2020
- Manzi S et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997;145:408-15American Journal of Epidemiology, 1997
- Hudson M et al. Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis: results from the International Scleroderma Renal Crisis Survey. Semin Arthritis Rheum 2014;43:666-72Seminars in Arthritis and Rheumatism, 2014
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback