Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents

  • Federico Carbone
  • Aldo Bonaventura
  • Luca Liberale
  • Sabrina Paolino
  • Francesco Torre
  • Franco Dallegri
  • Fabrizio Montecucco
  • Maurizio CutoloEmail author


Substantial epidemiological data identified cardiovascular (CV) diseases as a main cause of mortality in patients with rheumatoid arthritis (RA). In light of this, RA patients may benefit from additional CV risk screening and more intensive prevention strategies. Nevertheless, current algorithms for CV risk stratification still remain tailored on general population and are burdened by a significant underestimation of CV risk in RA patients. Acute CV events in patients with RA are largely related to an accelerated atherosclerosis. As pathophysiological features of atherosclerosis overlap those occurring in the inflamed RA synovium, the understanding of those common pathways represents an urgent need and a leading challenge for CV prevention in patients with RA. Genetic background, metabolic status, gut microbiome, and systemic inflammation have been also suggested as additional key pro-atherosclerotic factors. The aim of this narrative review is to update the current knowledge about pathophysiology of atherogenesis in RA patients and potential anti-atherosclerotic effects of disease-modifying anti-rheumatic drugs.


Rheumatoid arthritis Atherosclerosis Neutrophil extracellular traps Microbiome Single nucleotide polymorphisms Adipocytokines 



This study was supported by a grant from the European Commission (FP7-INNOVATION I HEALTH-F2-2013-602114; Athero-B Cell: Targeting and exploiting B cell function for treatment in cardiovascular disease), a grant from the Italian Ministry of Health to the Italian Cardiovascular Network and a grant from the Fondazione CARIGE to Prof. F. Montecucco.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Federico Carbone
    • 1
  • Aldo Bonaventura
    • 1
  • Luca Liberale
    • 1
    • 2
  • Sabrina Paolino
    • 3
    • 4
  • Francesco Torre
    • 4
    • 5
  • Franco Dallegri
    • 1
    • 6
  • Fabrizio Montecucco
    • 6
    • 7
  • Maurizio Cutolo
    • 4
    • 8
    Email author
  1. 1.First Clinic of Internal Medicine, Department of Internal MedicineUniversity of GenoaGenoaItaly
  2. 2.Center for Molecular CardiologyUniversity of ZürichSchlierenSwitzerland
  3. 3.Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal MedicineUniversity of Genoa, San Martino Polyclinic HospitalGenoaItaly
  4. 4.IRCCS Ospedale Policlinico San Martino GenoaGenoaItaly
  5. 5.Clinic of Emergency Medicine, Department of Internal MedicineUniversity of GenoaGenoaItaly
  6. 6.IRCCS Ospedale Policlinico San Martino Genoa—Italian Cardiovascular NetworkGenoaItaly
  7. 7.First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR)University of GenoaGenoaItaly
  8. 8.Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR)University of Genoa, San Martino Polyclinic HospitalGenoaItaly

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