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Cardiovascular Risk in the Rheumatic Disease Patient Undergoing Orthopedic Surgery

  • SURGERY AND PERIOPERATIVE CARE (CR MACKENZIE AND SM GOODMAN, SECTION EDITORS)
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Abstract

A hallmark of the rheumatic diseases, including systemic lupus erythematosis, spondyloarthritis, and rheumatoid arthritis, has been sustained inflammation, which typically targets the joint and may lead to joint destruction. Inflammation also plays a role in atherosclerotic cardiovascular disease, which is highly prevalent in patients with rheumatic diseases. Total joint arthroplasty, considered an intermediate cardiac risk procedure by the American College of Cardiology, maintains an important role in the management of rheumatic disease patients who progress to end-stage joints. The purpose of this article is to discuss the role of inflammation in cardiovascular disease, the prevalence of cardiovascular disease in patients with systemic rheumatic diseases, and the role of cardiovascular risk assessment when these patients undergo total joint arthroplasty.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Salmon JE, Roman MJ. Subclinical atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus. Am J Med. 2008;121(10 Suppl 1):S3–8.

    Article  PubMed  Google Scholar 

  2. Gabriel SE. Cardiovascular morbidity and mortality in rheumatoid arthritis. Am J Med. 2008;121(10 Suppl 1):S9–14.

    Article  PubMed  Google Scholar 

  3. Gladman DD, Ang M, Su L, Tom BD, Schentag CT, Farewell VT. Cardiovascular morbidity in psoriatic arthritis. Ann Rheum Dis. 2009;68(7):1131–5.

    Article  PubMed  CAS  Google Scholar 

  4. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5.

    Article  PubMed  Google Scholar 

  5. Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton 3rd LJ, Kurland RL, et al. A population-based study of trends in the use of total hip and total knee arthroplasty, 1969-2008. Mayo Clin Proc. 2010;85(10):898–904.

    Article  PubMed  Google Scholar 

  6. Massardo L, Gabriel SE, Crowson CS, O'Fallon WM, Matteson EL. A population based assessment of the use of orthopedic surgery in patients with rheumatoid arthritis. J Rheumatol. 2002;29(1):52–6.

    PubMed  Google Scholar 

  7. Mourao AF, Amaral M, Caetano-Lopes J, Isenberg D. An analysis of joint replacement in patients with systemic lupus erythematosus. Lupus. 2009;18(14):1298–302.

    Article  PubMed  CAS  Google Scholar 

  8. Zangger P, Esufali ZH, Gladman DD, Bogoch ER. Type and outcome of reconstructive surgery for different patterns of psoriatic arthritis. J Rheumatol. 2000;27(4):967–74.

    PubMed  CAS  Google Scholar 

  9. Urban MK, Jules-Elysee K, Loughlin C, Kelsey W, Flynn E. The one year incidence of postoperative myocardial infarction in an orthopedic population. HSS J. 2008;4(1):76–80.

    Article  PubMed  CAS  Google Scholar 

  10. Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96(5):1140–6.

    Article  PubMed  Google Scholar 

  11. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.

    Article  PubMed  CAS  Google Scholar 

  12. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto Jr AM, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195–207.

    Article  PubMed  CAS  Google Scholar 

  13. Ridker PM, Fonseca FA, Genest J, Gotto AM, Kastelein JJ, Khurmi NS, et al. Baseline characteristics of participants in the JUPITER trial, a randomized placebo-controlled primary prevention trial of statin therapy among individuals with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein. Am J Cardiol. 2007;100(11):1659–64.

    Article  PubMed  Google Scholar 

  14. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448–54.

    Article  PubMed  CAS  Google Scholar 

  15. Allaart CF, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Breedveld FC, Dijkmans BA, FARR study group. Aiming at low disease activity in rheumatoid arthritis with initial combination therapy or initial monotherapy strategies: the BeSt study. Clin Exp Rheumatol. 2006;24(6 Suppl 43):S,77–82.

    Google Scholar 

  16. Houten JK, Tandon A. Comparison of postoperative values for C-reactive protein in minimally invasive and open lumbar spinal fusion surgery. Surg Neurol Int. 2011;2:94.

    Article  PubMed  Google Scholar 

  17. Urban MK, Jules-Elysee KM, Beckman JB, Sivjee K, King T, Kelsey W, et al. Pulmonary injury in patients undergoing complex spine surgery. Spine J. 2005;5(3):269–76.

    Article  PubMed  Google Scholar 

  18. Currie CJ, Poole CD, Conway P. Evaluation of the association between the first observation and the longitudinal change in C-reactive protein, and all-cause mortality. Heart. 2008;94(4):457–62.

    Article  PubMed  CAS  Google Scholar 

  19. Poole CD, Conway P, Currie CJ. An evaluation of the association between C-reactive protein, the change in C-reactive protein over one year, and all-cause mortality in chronic immune-mediated inflammatory disease managed in UK general practice. Rheumatology (Oxford). 2009;48(1):78–82.

    Article  CAS  Google Scholar 

  20. Padayachee L, Rodseth RN, Biccard BM. A meta-analysis of the utility of C-reactive protein in predicting early, intermediate-term and long term mortality and major adverse cardiac events in vascular surgical patients. Anaesthesia. 2009;64(4):416–24.

    Article  PubMed  CAS  Google Scholar 

  21. • He LP, Tang XY, Ling WH, Chen WQ, Chen YM. Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies. Heart. 2010;96(5):339–46. This meta-analysis assessed the effect of CRP elevations after acute coronary syndrome and found an increase in risk for recurrent events with greater CRP elevation.

    Article  PubMed  CAS  Google Scholar 

  22. Verma S, Devaraj S, Jialal I. Is C-reactive protein an innocent bystander or proatherogenic culprit? C-reactive protein promotes atherothrombosis. Circulation. 2006;113(17):2135,50. discussion 2150.

    Google Scholar 

  23. Han C, Robinson Jr DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167–72.

    PubMed  Google Scholar 

  24. Avina-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59(12):1690–7.

    Article  PubMed  Google Scholar 

  25. Urowitz MB, Gladman D, Ibanez D, Fortin P, Sanchez-Guerrero J, Bae S, et al. Clinical manifestations and coronary artery disease risk factors at diagnosis of systemic lupus erythematosus: data from an international inception cohort. Lupus. 2007;16(9):731–5.

    Article  PubMed  CAS  Google Scholar 

  26. Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2005;52(2):402–11.

    Article  PubMed  Google Scholar 

  27. Shoenfeld Y, Gerli R, Doria A, Matsuura E, Cerinic MM, Ronda N, et al. Accelerated atherosclerosis in autoimmune rheumatic diseases. Circulation. 2005;112(21):3337–47.

    Article  PubMed  Google Scholar 

  28. del Rincon ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum. 2001;44(12):2737–45.

    Article  PubMed  Google Scholar 

  29. del Rincon I, Freeman GL, Haas RW, O'Leary DH, Escalante A. Relative contribution of cardiovascular risk factors and rheumatoid arthritis clinical manifestations to atherosclerosis. Arthritis Rheum. 2005;52(11):3413–23.

    Article  PubMed  Google Scholar 

  30. • Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Torp-Pedersen C, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis. 2011;70(6):929–34. Patients with RA and diabetes mellitus were identified in a nationwide cohort, and the risk of MI was analyzed; RA was associated with the same risk of MI as diabetes.

    Article  PubMed  Google Scholar 

  31. Gerson MC, Hurst JM, Hertzberg VS, Doogan PA, Cochran MB, Lim SP, et al. Cardiac prognosis in noncardiac geriatric surgery. Ann Intern Med. 1985;103(6 ( Pt 1)):832–7.

    Article  PubMed  CAS  Google Scholar 

  32. Solomon DH, Kremer J, Curtis JR, Hochberg MC, Reed G, Tsao P, et al. Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity. Ann Rheum Dis. 2010;69(11):1920–5.

    Article  PubMed  Google Scholar 

  33. • Greenberg JD, Kremer JM, Curtis JR, Hochberg MC, Reed G, Tsao P, et al. Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70(4):576–82. This large database study examined the association of TNFi use with cardiovascular events and found a reduced risk of cardiovascular events in RA treated with TNFi.

    Article  PubMed  Google Scholar 

  34. • Provan SA, Semb AG, Hisdal J, Stranden E, Agewall S, Dagfinrud H, et al. Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study. Ann Rheum Dis. 2011;70(5):812–7. Markers of cardiovascular disease risk were compared between active RA, RA in remission, and controls; inflammatory activity was associated with markers of cardiac risk.

    Article  PubMed  Google Scholar 

  35. Naranjo A, Sokka T, Descalzo MA, Calvo-Alen J, Horslev-Petersen K, Luukkainen RK, et al. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther. 2008;10(2):R30.

    Article  PubMed  Google Scholar 

  36. van Halm VP, Nurmohamed MT, Twisk JW, Dijkmans BA, Voskuyl AE. Disease-modifying antirheumatic drugs are associated with a reduced risk for cardiovascular disease in patients with rheumatoid arthritis: a case control study. Arthritis Res Ther. 2006;8(5):R151.

    Article  PubMed  Google Scholar 

  37. Dixon WG, Watson KD, Lunt M, Hyrich KL, British Society for Rheumatology Biologics Register Control Centre Consortium, Silman AJ, et al. Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2007;56(9):2905–12.

    Article  PubMed  CAS  Google Scholar 

  38. Roman MJ, Crow MK, Lockshin MD, Devereux RB, Paget SA, Sammaritano L, et al. Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2007;56(10):3412–9.

    Article  PubMed  CAS  Google Scholar 

  39. Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis. 2001;60(3):214–7.

    Article  PubMed  CAS  Google Scholar 

  40. Chen HA, Chen CH, Liao HT, Lin YJ, Chen PC, Chen WS, et al. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum. 2010; Sep 25.

  41. Cansu DU, Calisir C, Savas Yavas U, Kasifoglu T, Korkmaz C. Predictors of radiographic severity and functional disability in Turkish patients with ankylosing spondylitis. Clin Rheumatol. 2011;30(4):557–62.

    Article  PubMed  Google Scholar 

  42. Vander Cruyssen B, Munoz-Gomariz E, Font P, Mulero J, de Vlam K, Boonen A, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford). 2010;49(1):73–81.

    Article  Google Scholar 

  43. Sweeney S, Gupta R, Taylor G, Calin A. Total hip arthroplasty in ankylosing spondylitis: outcome in 340 patients. J Rheumatol. 2001;28(8):1862–6.

    PubMed  CAS  Google Scholar 

  44. Sochart DH, Porter ML. Long-term results of total hip replacement in young patients who had ankylosing spondylitis. Eighteen to thirty-year results with survivorship analysis. J Bone Joint Surg Am. 1997;79(8):1181–9.

    PubMed  CAS  Google Scholar 

  45. • Bremander A, Petersson IF, Bergman S, Englund M. Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis. Arthritis Care Res (Hoboken). 2011;63(4):550–6. This is a cohort study comparing the rate of common comorbidities and cardiovascular disease in ankylosing spondylitis patients; the rate of cardiovascular disease, as well as inflammatory eye and gastrointestinal disease, was increased.

    Article  Google Scholar 

  46. Mathieu S, Gossec L, Dougados M, Soubrier M. Cardiovascular profile in ankylosing spondylitis. A systematic review and metaanalysis. Arthritis Care Res (Hoboken). 2010; Oct 1.

  47. Papadakis JA, Sidiropoulos PI, Karvounaris SA, Vrentzos GE, Spanakis EK, Ganotakis ES, et al. High prevalence of metabolic syndrome and cardiovascular risk factors in men with ankylosing spondylitis on anti-TNFalpha treatment: correlation with disease activity. Clin Exp Rheumatol. 2009;27(2):292–8.

    PubMed  CAS  Google Scholar 

  48. Divecha H, Sattar N, Rumley A, Cherry L, Lowe GD, Sturrock R. Cardiovascular risk parameters in men with ankylosing spondylitis in comparison with non-inflammatory control subjects: relevance of systemic inflammation. Clin Sci (Lond). 2005;109(2):171–6.

    Article  CAS  Google Scholar 

  49. Peters MJ, van Eijk IC, Smulders YM, Serne E, Dijkmans BA, van der Horst-Bruinsma IE, et al. Signs of accelerated preclinical atherosclerosis in patients with ankylosing spondylitis. J Rheumatol. 2010;37(1):161–6.

    Article  PubMed  Google Scholar 

  50. Peters MJ, Voskuyl AE, Sattar N, Dijkmans BA, Smulders YM, Nurmohamed MT. The interplay between inflammation, lipids and cardiovascular risk in rheumatoid arthritis: why ratios may be better. Int J Clin Pract. 2010;64(10):1440–3.

    Article  PubMed  CAS  Google Scholar 

  51. Palazzi C, D'Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. 2008;26(3 Suppl 49):S131–4.

    PubMed  CAS  Google Scholar 

  52. Bergfeldt L, Edhag O, Vallin H. Cardiac conduction disturbances, an underestimated manifestation in ankylosing spondylitis. A 25-year follow-up study of 68 patients. Acta Med Scand. 1982;212(4):217–23.

    Article  PubMed  CAS  Google Scholar 

  53. Bergfeldt L, Edhag O, Vedin L, Vallin H. Ankylosing spondylitis: an important cause of severe disturbances of the cardiac conduction system. Prevalence among 223 pacemaker-treated men. Am J Med. 1982;73(2):187–91.

    Article  PubMed  CAS  Google Scholar 

  54. Dik VK, Peters MJ, Dijkmans PA, Van der Weijden MA, De Vries MK, Dijkmans BA, et al. The relationship between disease-related characteristics and conduction disturbances in ankylosing spondylitis. Scand J Rheumatol. 2010;39(1):38–41.

    Article  PubMed  CAS  Google Scholar 

  55. Yildirir A, Aksoyek S, Calguneri M, Oto A, Kes S. Echocardiographic evidence of cardiac involvement in ankylosing spondylitis. Clin Rheumatol. 2002;21(2):129–34.

    Article  PubMed  CAS  Google Scholar 

  56. Gladman DD, Chandran V. Observational cohort studies: lessons learnt from the University of Toronto Psoriatic Arthritis Program. Rheumatology (Oxford). 2010;Aug 6.

  57. Buckley C, Cavill C, Taylor G, Kay H, Waldron N, Korendowych E, et al. Mortality in psoriatic arthritis - a single-center study from the UK. J Rheumatol. 2010;Aug 3.

  58. Gladman DD. Mortality in psoriatic arthritis. Clin Exp Rheumatol. 2008;26(5 Suppl 51):S62–5.

    PubMed  CAS  Google Scholar 

  59. Tobin AM, Veale DJ, Fitzgerald O, Rogers S, Collins P, O'Shea D, et al. Cardiovascular disease and risk factors in patients with psoriasis and psoriatic arthritis. J Rheumatol. 2010;37(7):1386–94.

    Article  PubMed  Google Scholar 

  60. Tam LS, Shang Q, Li EK, Tomlinson B, Chu TT, Li M, et al. Subclinical carotid atherosclerosis in patients with psoriatic arthritis. Arthritis Rheum. 2008;59(9):1322–31.

    Article  PubMed  Google Scholar 

  61. Urowitz MB, Bookman AA, Koehler BE, Gordon DA, Smythe HA, Ogryzlo MA. The bimodal mortality pattern of systemic lupus erythematosus. Am J Med. 1976;60(2):221–5.

    Article  PubMed  CAS  Google Scholar 

  62. Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger Jr TA, Jansen-McWilliams L, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol. 1997;145(5):408–15.

    Article  PubMed  CAS  Google Scholar 

  63. Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001;44(10):2331–7.

    Article  PubMed  CAS  Google Scholar 

  64. Fischer LM, Schlienger RG, Matter C, Jick H, Meier CR. Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. Am J Cardiol. 2004;93(2):198–200.

    Article  PubMed  Google Scholar 

  65. Manzi S, Selzer F, Sutton-Tyrrell K, Fitzgerald SG, Rairie JE, Tracy RP, et al. Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum. 1999;42(1):51–60.

    Article  PubMed  CAS  Google Scholar 

  66. Asanuma Y, Oeser A, Shintani AK, Turner E, Olsen N, Fazio S, et al. Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003;349(25):2407–15.

    Article  PubMed  CAS  Google Scholar 

  67. Petri M, Perez-Gutthann S, Spence D, Hochberg MC. Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med. 1992;93(5):513–9.

    Article  PubMed  CAS  Google Scholar 

  68. Hak AE, Karlson EW, Feskanich D, Stampfer MJ, Costenbader KH. Systemic lupus erythematosus and the risk of cardiovascular disease: results from the nurses' health study. Arthritis Rheum. 2009;61(10):1396–402.

    Article  PubMed  Google Scholar 

  69. Roman MJ, Salmon JE. Cardiovascular manifestations of rheumatologic diseases. Circulation. 2007;116(20):2346–55.

    Article  PubMed  Google Scholar 

  70. Roman MJ, Shanker BA, Davis A, Lockshin MD, Sammaritano L, Simantov R, et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003;349(25):2399–406.

    Article  PubMed  CAS  Google Scholar 

  71. • Yazdanyar A, Wasko MC, Scalzi LV, Kraemer KL, Ward MM. Short-term perioperative all-cause mortality and cardiovascular events in women with systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2012;Dec 4. A cross-sectional analysis was performed on hospital discharge data, revealing that women with SLE are at higher risk for short term perioperative events.

  72. Domsic RT, Lingala B, Krishnan E. Systemic lupus erythematosus, rheumatoid arthritis, and postarthroplasty mortality: a cross-sectional analysis from the nationwide inpatient sample. J Rheumatol. 2010;37(7):1467–72.

    Article  PubMed  Google Scholar 

  73. Singh JA, Jensen MR, Harmsen WS, Gabriel SE, Lewallen DG. Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. Ann Rheum Dis. 2011;70(12):2082–8.

    Article  PubMed  Google Scholar 

  74. Basilico FC, Sweeney G, Losina E, Gaydos J, Skoniecki D, Wright EA, et al. Risk factors for cardiovascular complications following total joint replacement surgery. Arthritis Rheum. 2008;58(7):1915–20.

    Article  PubMed  Google Scholar 

  75. SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am. 2006;88(3):480–5.

    Article  PubMed  Google Scholar 

  76. Soohoo NF, Farng E, Lieberman JR, Chambers L, Zingmond DS. Factors that predict short-term complication rates after total hip arthroplasty. Clin Orthop Relat Res. 2010;468(9):2363–71.

    Article  PubMed  Google Scholar 

  77. • Yazdanyar A, Wasko MC, Kraemer KL, Ward MM. Perioperative all-cause mortality and cardiovascular events in patients with rheumatoid arthritis: Comparison with unaffected controls and persons with diabetes mellitus. Arthritis Rheum. 2012;64(8):2429–37. This study analyzed hospitalizations of patients undergoing noncardiac surgery and found that RA was not associated with perioperative cardiovascular risk or mortality.

    Article  PubMed  Google Scholar 

  78. Rho YH, Chung CP, Oeser A, Solus J, Asanuma Y, Sokka T, et al. Inflammatory mediators and premature coronary atherosclerosis in rheumatoid arthritis. Arthritis Rheum. 2009;61(11):1580–5.

    Article  PubMed  CAS  Google Scholar 

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Conflict of Interest

C. Ronald Mackenzie has served as a committee chair for the American College of Rheumatology.

Susan M. Goodman declares that she has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Hospital for Special Surgery, Weill Cornell College of Medicine, 535 E 70th St, New York, NY, 10021, USA

    Susan M. Goodman & C. Ronald Mackenzie

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Correspondence to Susan M. Goodman.

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This article is part of the Topical Collection on Surgery and Perioperative Care

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Goodman, S.M., Mackenzie, C.R. Cardiovascular Risk in the Rheumatic Disease Patient Undergoing Orthopedic Surgery. Curr Rheumatol Rep 15, 354 (2013). https://doi.org/10.1007/s11926-013-0354-y

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