Which statement about RA and cardiovascular risk is true?

• A. RA has no impact on cardiovascular risk
• B. Persistent high disease activity is associated with higher cardiovascular risk
• C. Only smokers with RA have increased risk
• D. Cardiovascular risk decreases with RA progression

Answer: (B)

In rheumatoid arthritis, ongoing systemic inflammation drives cardiovascular risk upward. The true statement is that persistent high disease activity is associated with higher cardiovascular risk. When inflammation remains active, immune mediators promote endothelial dysfunction and accelerated atherosclerosis, increasing the chances of heart attacks and strokes. Therefore, higher RA activity translates to greater cardiovascular risk, and reducing disease activity with DMARDs or biologics helps lower that risk over time.

The other ideas aren’t correct because RA itself raises cardiovascular risk beyond traditional factors, not just in smokers; risk does not decrease as RA progresses—if anything, risk tends to rise with sustained activity and longer disease exposure.