“Cardiovascular” Drugs in Rheumatoid Arthritis: Killing Two Birds with One Stone?

The introduction of statins and drugs blocking the renin angiotensin aldosterone system in the treatment of cardiovascular diseases (CVD) in the general population has led to substantial reductions in morbitity and mortality. Recent evidence suggests multiple actions of these agents, including modulation of the immune response and attenuation of inflammation. Even though several studies have addressed the anti-inflammatory properties of these drugs in the general population, only few studies have focused on their potential benefit when administered to patients with rheumatoid arthritis (RA), a chronic systemic disease characterised by both inflammatory joint damage and excess cardiovascular mortality. The present review focuses on the potential role of these agents in reducing the excess CVD (by controlling cardiovascular risk factors, improving endothelial dysfunction, reducing size and increasing stability of atheromatous plaques, activating the fibrinolytic system and reducing systemic inflammation) and in controlling the disease itself (both systemic and localised joint inflammation), in RA patients. Overall, the review has strong evidence to support the effects of statins on reducing cardiovascular risk, however by comparison the evidence supporting their efficacy in RA is relatively weak.