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Special Populations
Chart 14. Patients with Rheumatoid Arthritis (RA)
Recommendations
Strength Quality
Clinicians should be aware that patients with RA are at
increased risk for ASCVD. e association of RA and
systemic lupus erythematosus with ASCVD risk raises
concern that other inflammatory conditions may also be
associated with increased ASCVD risk. However, only RA
has been studied sufficiently to accurately quantify the degree
to which it increases ASCVD risk.
A High
e association between RA and ASCVD risk is
independent of the risk associated with major established
ASCVD risk factors.
A High
For primary prevention of ASCVD, RA may be counted as
an additional ASCVD risk factor for risk stratification.
B Moderate
Risk stratification is based on the NLA Recommendations
for the Patient-Centered Management of Dyslipidemia –
Part 1 with initial risk stratification based on the number of
major ASCVD risk factors (with the caveat that the presence
of RA may be counted as an additional risk factor), the use
of risk prediction tools, such as the ATP III Framingham
Risk Score or the ACC/AHA Pooled Cohort Equations
if two risk factors are present, and the use of other clinical
indicators to help inform clinical judgment, if needed.
B Moderate
Clinicians should be vigilant in ensuring that RA patients
are routinely assessed for cardiovascular risk factors, such
as hypertension, dyslipidemia, diabetes, family history of
early-onset ASCVD, and smoking. Calculation of lifetime
ASCVD risk can be considered for patients age 20–59 years.
B Moderate
Statins are generally the first-line treatment for dyslipidemia
in RA.
A Moderate
At this time, atherogenic cholesterol treatment goals for
patients with RA and other inflammatory diseases are the
same as described in the NLA Recommendations for Patient-
Centered Management of Dyslipidemia – Part 1.
B Moderate
If an RA patient has had lipid levels checked during an RA
flare, it is recommended that the lipids be re-checked when
the disease is controlled.
B Moderate
