Premature Atherosclerosis, and Arterial stiffness as a Challenge in Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) have an increased morbidity and mortality due to cardiovascular disease (CVD) [1]. Traditional cardiovascular (CV) risk factors cannot fully explain the increase but inflammation has been shown to contribute to the increased CVD among these patients [2]. The pro-inflammatory cytokines such as tumor necrosis factor alpha and interleukin-6, involved in the pathogenesis of RA, are also independently predictive of subsequent cardiovascular disease (CVD). In RA, inflammation alters HDL constituents and the concentration of LDL and HDL, thus facilitating atherosclerosis and CVD events. On the other hand, also the increase of oxidative processes, frequently observed in RA, induces atherosclerosis. Interestingly, some genetic polymorphisms associated with RA occurrence enhance atherosclerosis [3]. This means that atherosclerosis in RA is multifactorial, not related to single hit but mostly a combination of factors including genetic polymorphism.