Cardiovascular disease risk in immune-mediated inflammatory diseases: recommendations for clinical practice.

### Learning objectives Immune-mediated inflammatory diseases (IMIDs) comprise a wide range of conditions of which rheumatoid arthritis (RA), spondyloarthritis (SpA) and inflammatory bowel disease (IBD; ie, Crohn’s disease and ulcerative colitis) are most common (table 1, table 2). SpA consists of a range of diseases, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis, spondylitis associated with IBD and undifferentiated SpA.1 As data regarding cardiovascular disease (CVD) risk are mainly available for RA, AS, PsA, severe psoriasis and IBD, we will focus on these conditions. View this table: Table 1 Main characteristics of the most common immune-mediated inflammatory diseases View this table: Table 2 Glossary IMIDs are associated with increased mortality when compared with the general population (table 1). Reported standardised mortality ratios (SMRs) range from 0.9 to 2.7 for RA, from 1.6 to 1.9 for SpA, and from 1.2 to 1.5 for IBD.2 3 Majority of these excess deaths are caused by CVD, at least in patients with RA and SpA.4 A meta-analysis of 14 observational studies, including 40 000 patients with RA, showed an age-adjusted and sex-adjusted relative risk (RR) of 1.48 (95% CI 1.36 to 1.62) for a first CVD event, mainly driven by an increased risk of myocardial infarction (MI) and stroke.5 The available studies report an HR of 1.36 (95% CI 1.13 to 1.65) in patients with AS and 1.24 (95% CI 1.03 to 1.49) in patients with PsA for major atherosclerotic events after adjustment for traditional cardiovascular (CV) risk factors.6 …