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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4032_Библиотеки_им_академика_М_И_Перельмана
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108 • HANDBOOK OF CARDIOVASCULAR DISEASE MANAGEMENT IN RHEUMATOID ARTHRITIS
New medications to treat both indications
There are several new medications for CVD prevention, and the most
promising at the moment is alirocumab/evolocumab (proprotein con-
vertase subtilisin/kexin type 9 [PCSK9] inhibitors), which is recommended
to patients with primary hypercholesterolemia who do not achieve lipid
goals with statins. An interesting clinical indication is patients with statin
intolerance, but until now alirocumab has only been tested in addition
to statin medication.
The evolution of biological disease-modifying anti-rheumatic drugs
(bDMARDs) has revolutionized outcomes for patients with RA, and
almost abolished the crippling joint destructions so commonly previously
seen in these patients. The newest generations of bDMARDs the Janus
kinase (JAK) inhibitors seem promising but effects on CVD outcome
are still unknown for both the conventional bDMARDs and the newer
generation of these drugs.
Future outlook and overarching goals
During the past decades, anti-rheumatic treatment has been develop-
ing in addition to ‘treat-to-target’ and tight disease control strategies,
which together have improved the outcome for patients with rheumatic
disease immensely. Improved disease control may also be of importance
for reduction of CVD in patients with RA. Therefore, future studies will
reveal whether remission is the mission not only for joint disease but also
for prevention of CVD in patients with rheumatoid arthritis.
The increased risk of CVD in R A patients has been known for decades
and implementing this into clinical practice is one of the large challenges.
The awareness of the high CVD risk in RA patients is low both among the
patients themselves and among health personnel. In addition, CVD risk
recording and risk evaluation is inadequate in R A patients. Furthermore,
patients with RA are also undertreated with CVD preventive medica-
tion both in primary prevention and after they have had a CVD event.
Therefore, the overarching goal for patients with RA should be that they
will have a structured system for CVD prevention equal to that of other
high-risk patient groups, such as those with diabetes mellitus, familial
hypercholesterolemia, hypertension, heart failure, and chronic kidney
https://t.me/med1917
CONCLUSIONS • 109
disease. This includes specific risk algorithms, guidelines for CVD pre-
vention, and specialized personnel; an example being diabetic nurses
for patients with diabetes mellitus.
https://t.me/med1917
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