Future directions for cardio-rheumatology

Patients with inflammatory rheumatic diseases have an increased risk of cardiovascular disease (CVD) in comparison to the general population. The higher CVD in patients with rheumatic diseases is not sufficiently explained by differences in the prevalence of traditional CVD factors. The majority of rheumatologic diseases are uncommon, therefore limiting the ability to perform large observational studies to assess the impact of traditional and disease-specific risk factors on CVD burden and clinical trials on the long-term cardiovascular effects of preventive treatments. The small cohort size limits the generation of Class I evidence-based guidelines that typically require randomized, controlled clinical trials. Future research for improving CVD management in rheumatic and musculoskeletal diseases has been summarized by the European League Against Rheumatism (EULAR) multidisciplinary task force. Specifically, individual patient clinical phenotype for CVD risk assessment and cardiovascular prognosis also merits further investigation. One of challenges is the better identification of patient subgroups at higher CVD risk, including, for example, those with longer disease duration and a number of flares/relapses (or those with certain demographic and disease characteristics). Long-term effects of current and new drugs for rheumatologic diseases on CVD need further investigation.