Cardiovascular risk in women with inflammatory arthritis: Unmet needs in lipid management

How can cardiovascular risk factors be better managed in women with inflammatory RMDs? Research from EULAR highlights the key unmet needs in care.

Inflammatory rheumatic and musculoskeletal diseases (RMDs) are associated with an elevated cardiovascular disease risk in women, reflecting the combined effects of systemic inflammation and traditional cardiovascular risk factors.

In this interview, Editorial Board member Dr Alessia Alunno (University of L’Aquila, Italy) explains the incidence and risk of CVD in people with rheumatic diseases. Dr Alunno discusses the aims, methodology of her study looking at CVD risk in women with inflammatory arthritis and the findings over a 12-month period.

Abstract: Identifying gaps in the cardiovascular risk management of women with spondyloarthritis and rheumatoid arthritis: when lipid-lowering therapy falls short. EULAR 2026, June 3– 6, London, UK.

I am Alessia Alunno, a rheumatologist working at the Internal Medicine Division of University of L’Aquila in Italy. My main research interests are cardiovascular risk and cardiovascular disease in patients with RMDs, as well as patient education, with a particular focus on addressing unmet needs related to patient empowerment and improving understanding of the disease and its potential manifestations.

What is known about the incidence and risk of CVD in people with rheumatic diseases?

Over the last couple of decades, several studies have shown that patients living with inflammatory RMDs carry a higher cardiovascular risk than the general population. This increased risk is not explained solely by traditional risk factors such as smoking, obesity, or diabetes, but also by disease-specific factors, including the burden of chronic inflammation and the impact of treatment.

Epidemiological data show that patients with RMDs are more likely to experience cardiovascular events, such as myocardial infarction and cerebrovascular disease. Importantly, these events also tend to occur at a younger age than in the general population, largely because of additional risk factors that are independent of the aging process.

What were the aims and rationale of your study looking at CVD risk in women with inflammatory RMDs?

We know that most inflammatory RMDs disproportionately affect women, and we wanted to better understand this issue. In the general population, cardiovascular disease in women is often under-recognized and undertreated, representing an important unmet need. This is particularly relevant for people with RMDs, who already have an increased cardiovascular risk.

In our study, we aimed to assess how traditional cardiovascular risk factors are managed in women with RMDs and to identify potential opportunities for improvement. Our goal was to generate evidence that could serve as a basis for future studies in this area.

What was the methodology of your study?

This was a cross-sectional study. We recruited female patients referred to our institution with a diagnosis of rheumatoid arthritis, spondyloarthritis or psoriatic arthritis. Participants could be either newly diagnosed or already under follow-up care.

We assessed all cardiovascular risk factors of interest, with a particular focus on the lipid assessment, including cholesterol and triglyceride levels. We also recorded all the cardiovascular treatments the patients were receiving. For those taking cardiovascular treatments, we evaluated whether they were achieving recommended targets for blood pressure, cholesterol levels, and other relevant cardiovascular risk factors.

What unmet needs did the study identify over a 12-month period?

The main unmet need we identified was that many patients with hypercholesterolemia were not achieving their cholesterol targets despite being on treatment. We explored the reasons for this in more detail and found that the primary factor was poor adherence to treatment, either because patients were concerned about potential adverse effects or because they did not fully understand why the treatment was necessary.

This was followed by challenges in the patient–physician relationship, particularly with general practitioners. In some cases, patients felt they were not receiving sufficient support or encouragement to maintain adherence to their treatment.

We also identified an overall issue regarding target cutoff values. While laboratory reports provide numerical results and reference ranges, the appropriate target must be determined by the physician based on the patient’s additional cardiovascular risk factors. As a result, patients who are only slightly above the laboratory cutoff may not realize how important it is for them to achieve the recommended target levels.

Overall, the key message is that there is a lack of adequate patient education and empowerment regarding cardiovascular prevention, particularly in the context of lipid-lowering therapy.

What will be the likely clinical impact of these findings?

We aim to communicate more with general practitioners and really highlight the need for collaboration between the specialist and general practice. It is important that patients are supported throughout the cardiovascular prevention journey, particularly younger patients who are less frequently assessed. Evaluation should start as early as possible in patients with RMDs. We truly hope to implement this in the primary care, not only in tertiary care.