Cardiovascular Risk in Rheumatoid Arthritis Save

Cardiovascular risk is an established part of rheumatoid arthritis (RA) care, but recognising a risk is not the same as treating it. Two abstracts at ACR Convergence 2026 highlight this. One examines the contribution of cardiovascular health to dementia risk, while the other identifies a substantial gap in statin use among patients already at increased cardiovascular risk.

What is the link between cardiovascular risk and dementia?

In abstract 1454, Michelle Allen and colleagues at Mayo Clinic studied 2,483 adults with incident RA diagnosed between 1980 and 2019. Patients were followed for Alzheimer’s disease and related dementias, with the researchers examining cardiovascular risk factors, cardiovascular events and RA-related characteristics.

It was estimated that cardiovascular risk factors and events accounted for 44% of the dementia burden over 10 years (95% CI 18-64%). Adding measures of cumulative inflammation based on ESR only slightly changed this estimate, to 44-46%.

These estimates describe the contribution of these factors across the population, not an individual patient’s risk. Nevertheless, the findings suggest that cardiovascular health is an important part of understanding dementia risk in RA. Controlling joint inflammation should not lead us to assume that comorbidities, and long-term risks and prognosis, have been addressed.

Are higher-risk patients receiving statins?

Abstract #2900, by Jon Giles and colleagues, examined US insurance claims for 24,039 patients with RA starting advanced therapy between 2019 and 2025. All were aged at least 50 years and had at least one additional cardiovascular risk factor.

Statin use was recorded in 39.4% overall during the 30-day baseline period. Among patients with established atherosclerotic cardiovascular disease, the proportion was 61.4%, leaving almost four in ten without recorded baseline statin use. Of those with established disease who were not taking a statin at baseline, only 17.8% started one during follow-up.

Within the group with established cardiovascular disease, statin users and non-users had broadly similar cardiovascular risk profiles and use of preventive healthcare. The authors identified an important gap in routine cardiovascular prevention, particularly in patients who had already developed disease.

What can we do to improve our management of cardiovascular risk factors?

We have long known about the risks of cardiovascular disease, thrown further into the spotlight in the wake of ORAL surveillance, which highlighted the risk of cardiovascular disease with JAK inhibitors. While these studies ask different questions, together they give us a practical reason to review cardiovascular care rather than simply record the risk.

For example, approaches such as the annual RA review, recommended in the UK by the National Institute for Health and Care Excellence (NICE) and the British Society for Rheumatology, is an opportunity to check for comorbidities, as well as assessing disease control. Reviewing blood pressure, smoking status, diabetes and lipid results can identify problems requiring action. For patients without established cardiovascular disease, formal risk assessment can inform a discussion about prevention. For those with established disease, lipid-lowering treatment is part of standard secondary prevention.

Rheumatologists do not need to manage every aspect of cardiovascular health. The key is to signpost to the appropriate services and investigations, and take a multidisciplinary approach, whether that be involving primary care, the pharmacist, cardiologist or wider members of the team. It should be agreed, with the patient, who will review an untreated risk factor, arrange follow-up and discuss treatment options.

Improving long-term outcomes in RA requires attention to cardiovascular health as well as inflammatory disease control. The findings from the Mayo Clinic study suggest that cardiovascular factors may also contribute to dementia risk, while the statin study shows that preventive treatment remains incomplete even in patients with established cardiovascular disease. We already consider cardiovascular risk when selecting treatment for RA. We should be just as consistent about ensuring that those risks are being addressed, with appropriate treatment and follow-up, rather than assessing and addressing disease activity alone.