Analysis of Factors Contributing to the Development of Cardiovascular Disorders and Atherosclerotic Changes in Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease primarily characterized by symmetrical involvement of peripheral joints and a wide spectrum of extra-articular manifestations. Patients with RA exhibit significantly higher morbidity and mortality rates than those observed in the general population, with cardiovascular disease representing one of the leading causes of death. The prevalence of traditional atherosclerotic risk factors is substantially higher among individuals with RA than among those without the disease. Numerous studies have demonstrated an increased frequency of concomitant conditions, including arterial hypertension, dyslipidemia, obesity, and diabetes mellitus, in this patient population. Nevertheless, the markedly elevated incidence of cardiovascular events in RA cannot be fully explained by conventional risk factors alone. Generalized systemic inflammation, accompanied by excessive production of pro-inflammatory cytokines and elevated levels of acute-phase proteins, is considered a major contributor to the initiation and progression of premature atherosclerotic changes. This review provides a comprehensive analysis of cardiovascular risk in rheumatoid arthritis, the distinctive features of RA-associated dyslipidemia, the phenomenon known as the "lipid paradox," and the impact of chronic systemic inflammation on the development and progression of atherosclerosis in patients with RA.