Main Article Content


Despite rheumatoid arthritis (RA) therapy development has been in advance level today, its mortality remains increasing in general population. The mortality is mainly caused by early-manifested atherosclerosis and other cardiovascular complications. Available evidences show
this condition appears in early stage of the disease. Thus, early detection and management of cardiovascular risk, followed by control of these factors are necessaryto reduce morbidity and mortality of RA patients

Article Details

How to Cite
Utari, A. P., Hidayat, R., & Setiyohadi, B. (2018). Risk of cardiovascular disease in rheumatoid arthritis patients. Indonesian Journal of Rheumatology, 3(1).


  1. Lloyd-Jones D, Adams RJ, BrownM TM, Carnethon e, Dai S, Simone GD, et al.Heart Disease and Stroke Statistics 2010 Update: A Report From the American Heart Association. Circulation. 2010;121(e46-215).
  2. British Heart Foundation Statistics Database. Coronary Heart Disease Statistics. 7 ed; 2010.
  3. National Institute of Health Research and Development, Ministry of Health Republic of Indonesia. Basic Health Research [Riset Kesehatan Dasar] 2007. 2008.
  4. Friedewald VE, Ganz P, Kremer JM, Mease PJ, O’Dell JR, Pearson TA, et al.AJC Editor’s Consensus: Rheumatoid Arthritis and Atherosclerotic Cardiovascular Disease. Am J Cardiol 2010;106:442-47.
  5. Harris ED, Firestein GS. Clinical Features of Rheumatoid Arthritis. In: Firestein GS, Budd RC, Harris ED, McInnes IB, Ruddy S, Sergent JS, eds. Kelley’s Textbook of Rheumatolgy. 8 ed. Philadelphia: Saunders; 2008.
  6. Scott D, Wolfe F, TWJ H. Rheumatoid Arthritis. Lancet. 2010;376:1094-108.
  7. Darmawan J, Muirden KD, Valkenburg HA, Wigley RD. The epidemiology of rheumatoid arthritis in Indonesia. British Journal of Rheumatology. 1993;32:537-40.
  8. Bowes J, Barton A. Recent advances in the genetics of RA susceptibility. Rheumatology. 2008;47:399-402.
  9. Kaplan M. Cardiovascular Complications of Rheumatoid Arthritis:Assessment, Prevention, and Treatment. Rheum Dis Clin N Am.2010;36:405-26.
  10. A-Zubieta J, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of Cardiovascular Mortality in Patients With Rheumatoid Arthritis: A Meta-Analysis of Observational Studies. Arthritis & Rheumatism.2008;59(12):1690-7.
  11. Van Halm VP, Peters MJL, Voskuyl AE, Boers M, Lems WF, Visser M, et al.Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease, a cross-sectional study. The CARRÉ Investigation. Ann Rheum Dis. 2008.
  12. Lindhardsen J, Ahlehoff O, Gislason GH, Ole Rintek Madsen, Olesen JB, Torp-Pedersen C, et al.The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum. 2011(70):929-34.
  13. Shoenfeld Y, Gerli R, Doria A, Matsuura E, Cerinic MM, Ronda N, et al.Accelerated Atherosclerosis in Autoimmune Rheumatic Diseases. Circulation. 2005;112:3337-47.
  14. Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, et al.Cardiovascular Morbidity and Mortality in Women Diagnosed With Rheumatoid Arthritis. Circulation. 2003;107:1303-7.
  15. John H, Kitas G, Toms T, Goodson N. Cardiovascular Co-morbidity in Early Rheumatoid Arthritis. Best Practice & Research Clinical Rheumatology. 2009;23:71-82.
  16. Fietta P, Delsante G. Atherogenesis in rheumatoid arthritis: the “rheumatoid vasculopathy� Acta Biomed. 2009;80:177-86.
  17. Boyer J-F, Gourrau P-A, Cantagrel A, Davignon J-L, Constantina A. Traditional Cardiovascular Risk Factors in Rheumatoid Arthritis:A Metaanalysis. Joint Bone Spine. 2010.
  18. Fernandez-Real JM, Vayreda M RC, Gutierrez C, Broch M, Vendrell J, W. R. Circulating Interleukin 6 Levels, Blood Pressure, and Insulin Sensitivity in Apparently Healthy Men and Women. J Clin Endocrinol Metab. 2001;86(3):1154-9.
  19. Kim TH, Choi SE, Ha ES, Jung JG, Han SJ, Kim HJ, et al.IL-6 induction of TLR-4 gene expression via STAT3 has an effect on insulin resistance in human skeletal muscle. Acta Diabetol. 2011 [Epub ahead of print].
  20. Schultz O, Oberhauser F, Saech J, Rubbert-Roth A, Hahn M, Krone W, et al.Effects of inhibition of interleukin-6 signalling on insulin sensitivity and lipoprotein (A) levels in human subjects with rheumatoid diseases. PLoS ONE. 2010;5(12):e14328.
  21. Brady SRE, Courten Bd, Reid CRM, Cicuttini FM, Courten MPJd, Liew D. The Role of Traditional Cardiovascular Risk Factors Among Patients with Rheumatoid Arthritis. The Journal of Rheumatology. 2009;36:34-40.
  22. Wasko MC, Kay J, Hsia EC, Rahman MU. Diabetes and insulin resistance in patients with rheumatoid arthritis: risk reduction in a chronic infl ammatory disease. Arthritis Care Res (Hoboken) [Epub ahead of print]. 2010.
  23. Solomon DH, Love TJ, Canning C, Schneeweiss S. The Risk of Diabetes Among Patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Psoriasis. Ann Rheum Dis. 2010;69(12):2114-7.
  24. Hoes JN, van der Goes MC, van Raalte DH, van der Zijl NJ, den Uyl D, Lems WF, et al.Glucose tolerance, insulin sensitivity and β-cell function in patients with rheumatoid arthritis treated with or without low-tomedium dose glucocorticoids. Ann Rheum Dis. 2011;70(11):1887-94.
  25. Panoulas VF, Metsios GS, Pace AV, John H, Treharne GJ, Banks MJ, et al.Hypertension in rheumatoid arthritis. Rheumatology. 2008;47:1286-98.
  26. Serelis J, Panangiotakos DB, Mavrommati M, Skopouli FN. Cardiovascular Disease Is Related to Hypertension in Patients with Rheumatoid Arthritis:A Greek Cohort Study. J Rheumatol. 2010.
  27. Toms TE, Panoulas VF, Kitas GD. Dyslipidaemia in rheumatological autoimmune diseases The Open Cardiovascular Medicine Journal. 2011;5:64-75.
  28. Khovidhunkit W, Kim M-S, Memon RA, Shigenaga JK, Moser AH, Feingold KR, et al.Effects of infection and infl ammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host. J. Lipid Res. 2004;45:1169-96.
  29. McMahon M, Grossman J, FitzGerald J, Dahlin-Lee E, Wallace DJ, Thong BY, et al.Proinfl ammatory high-density lipoprotein as a biomarker for atherosclerosis in patients with systemic lupus erythematosus and rheumatoid arthritis. Arthritis & Rheumatism. 2006;54(8):2541–9.
  30. Charles-Schoeman C, Watanabe J, Lee YY, Furst DE, Amjadi S, Elashoff D, et al.Abnormal Function of high-density lipoprotein (HDL) is associated with poor disease control and an altered HDL protein cargo in rheumatoid arthritis. Arthritis Rheum. 2009;60(10):2870-9.
  31. Elkan A-C, Håkansson N, Frostegård J, Cederholm T, Hafström I. Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Research & Therapy. 2009;11(R37).
  32. Toms TE, Panoulas VF, Jacqueline P. Smith, Karen M.J. Douglas, Giorgos S. Metsios, Antonios Stavropoulos-Kalinoglou, et al.Rheumatoid arthritis susceptibility genes associate with lipid levels in patients with rheumatoid arthritis Ann Rheum Dis 2011;70:1025-32.
  33. Bisoendial RJ, Levi M, Tak P-P, Stroes ESG. The prothrombotic state in rheumatoid arthritis: an additive risk factor for adverse cardiovascular events. Semin Thromb Hemost 2010;36:452-7.
  34. Turesson C, Matteson EL. Vasculitis in rheumatoid arthritis. Current Opinion in Rheumatology. 2009;21:35-40.
  35. Pieringer H, Pichler M. Cardiovascular Morbidity and Mortality in Patients with Rheumatoid Arthritis: Vascular Alterations and Possible Clinical Implications. QJM. 2010.
  36. Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C. Do Selective Cyclo-Oxygenase-2 Inhibitors and Traditional Non-Steroidal Anti-Infl ammatory Drugs Increase the Risk of Atherothrombosis? Metaanalysis of Randomised Trials. BMJ. 2006;332:1302-8.
  37. Choi HK, Hernán MA, Seeger JD, Robins JM, F. W. Methotrexate and Mortality in Patients with Rheumatoid Arthritis: A Prospective Study. Lancet. 2002;359:1173-7.
  38. Toms TE, Panoulas VF, John H, Douglas KM, Kitas GD. Methotrexate Therapy associates with reduced prevalence of the metabolic syndrome in rheumatoid arthritis patients over the age of 60- more than just an anti-infl ammatory effect? A cross sectional study. Arthritis Research & Therapy 2009;11(5).
  39. Ridker P. Testing the Infl ammatory Hypothesis of Atherothrombosis:
  40. Scientifi c Rationale For the Cardiovascular Infl ammation ReductionTrial
  41. (CIRT). J Thromb Haemost. 2009;7:332-9.
  42. Dixon WG, Watson KD, Lunt M, Hyrich KL. Reduction in the Incidence of Myocardial Infarction in Patients With Rheumatoid Arthritis Who Respond to Anti–Tumor Necrosis Factor Therapy. Arthritis & Rheumatism. 2007;56(9):2905-12.
  43. Greenberg JD, Kremer JM, Curtis JR, Hochberg MC, Reed G, Tsao P, et al.Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis. AnnRheum Dis. 2011:576-82.
  44. SK A. Core management principles in rheumatoid arthritis to help guide managed care professionals. J Manag Care Pharm. 2011;17(9-):S3-8.
  45. Ikonomidis I, Lekakis JP, Nikolaou M, Paraskevaidis I, Andreadou I, Kaplanoglou T, et al.Inhibition of interleukin-1 by anakinra improves vascular and left ventricular function in patients with rheumatoid arthritis.Circulation. 2008;117:2662-9.
  46. Kerekes G, Soltész P, Dér H, Veres K, Szabó Z, Végvári A, et al.Effects of rituximab treatment on endothelial dysfunction, carotid atherosclerosis, and lipid profi le in rheumatoid arthritis. Clin Rheumatol. 2009;28(6):705-10.
  47. Kume K, Amano K, Yamada S, Hatta K, Ohta H, Kuwaba N. Tocilizumab monotherapy reduces arterial stiffness as effectively as etanercept or adalimumab monotherapy in rheumatoid arthritis: an open-label randomized controlled trial. J Rheumatol. 2011;38(10):2169-71.
  48. Peters MJL, Symmons DPM, McCarey D, Dijkmans BAC, Nicola P, Kvien TK, et al.EULAR Evidence-Based Recommendations For Cardiovascular Risk Management in Patients with Rheumatoid Arthritis and Other Forms of Infl ammatory Arthritis. Ann Rheum Dis 2010;69:325-31.
  49. Trial of Atorvastatin in Rheumatoid Arthritis (TARA): Double-blind, Randomised Placebo-controlled Trial. Lancet. 2004;363:2015-21.
  50. El-Barbar y AM, Hussein MS, Rageh EM, Hamouda HE, Wagih AA, Ismail RG. Effect of atorvastatin on infl ammation and modifi cation of vascular risk factors in rheumatoid arthritis. J Rheumatol. 2011;38(2):229-35.

Most read articles by the same author(s)