Atherosclerotic Cardiovascular Disease (ASCVD) in Rheumatoid Arthritis (RA)—Indian Perspective

Reduced life expectancy in rheumatoid arthritis (RA) has been recognised since the 1950s, with standardised mortality rates (SMRs) of 1.41 for females and 1.08 for males. Extensive studies worldwide, including in India, have attributed this to a high prevalence of atherosclerotic cardiovascular disease (ASCVD) in RA. The increased ASCVD risk in RA and other inflammatory rheumatic and musculoskeletal diseases (I-RMDs) is influenced not only by conventional ASCVD risk factors (such as hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and family history) but also by the degree and duration of systemic inflammation, as indicated by high-sensitivity C-reactive protein (hs-CRP) levels. Therefore, preventing ASCVD in RA and other I-RMDs has become a critical responsibility for rheumatologists. A two-pronged strategy is recommended: (a) strict lipid control and (b) stringent management of systemic inflammation, measured by hs-CRP levels. This article summarises the Lipid Association of India (LAI) guidelines for preventing ASCVD in RA and other I-RMDs, which can be implemented by specialist rheumatologist-nurse-led teams in rheumatology clinics and departments.