The European League Against Rheumatism has issued new recommendations for cardiovascular risk management in various rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. These recommendations aim to guide clinical practice and future research to improve cardiovascular risk management in these patient populations.
Objective
The objective was to develop recommendations for cardiovascular risk (CVR) management in patients with gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), and antiphospholipid syndrome (APS).
Methods
Following EULAR standardized procedures, a multidisciplinary task force conducted systematic literature reviews and integrated expert opinions to formulate the recommendations. The task force included rheumatologists, cardiologists, metabolic medicine physicians, health care professionals, and patient representatives.
Results
The task force endorsed four overarching principles emphasizing the need for (1) regular screening, (2) management of modifiable CVR factors, (3) patient education, and (4) increased awareness of elevated CVR in rheumatic and musculoskeletal diseases.
Nineteen specific recommendations were developed, covering three main areas:
- CVR Prediction Tools
- Use of generic CVR prediction tools
- Supplementary use of the European Vasculitis Society model in ANCA-associated vasculitis
- Interventions on Traditional CVR Factors
- Blood pressure management in general
- Lower blood pressure target for SLE patients
- Lipid management
- Avoidance of diuretics in gout
- Avoidance of beta-blockers in SSc
- Low-dose aspirin for primary prevention not routinely recommended
- Antiplatelet use in SLE, APS, and large-vessel vasculitis
- Serum uric acid target in gout
- No preference for a particular urate-lowering therapy in gout
- Interventions on Disease-Related CVR Factors
- Disease activity control and glucocorticoid dose minimization in SLE and vasculitis
- Remission induction and maintenance in ANCA-associated vasculitis
- Optimal glucocorticoid regimen in giant cell arteritis
- Maintenance of low disease activity in SLE
- Hydroxychloroquine in SLE
- Low-dose aspirin in asymptomatic antiphospholipid antibody carriers with high-risk profile
- No specific immunosuppressive treatment in SLE for CVR reduction
- No specific urate-lowering therapy in gout for CVR reduction
Conclusion
The recommendations, published in Annals of Rheumatic Diseases, provide a structured approach to managing CVR in patients with rheumatic and musculoskeletal diseases. Regular screening, management of traditional and disease-related risk factors, and patient education are important components.
The recommendations also highlighted areas needing further research, particularly in developing and validating disease-specific CVR prediction tools and evaluating long-term cardiovascular outcomes of current and new treatments.
"Most of the recommendations of established low-cost clinical interventions may apply to high-resource and low-resource countries worldwide," the authors noted. "The panel believes that these recommendations will enable health care providers and patients to mutually engage in a long-term care pathway tailored to patients' needs and expectations."
The guidelines will be updated as new evidence emerges to ensure optimal cardiovascular health for patients with rheumatic and musculoskeletal diseases.
Ethic statements were not made available at time of publishing.
