Other non-traditional risk factors may also contribute to cardiovascular risk, and include the long-term effects of non-steroidal anti-inflammatory drug (NSAID) treatment, and the use of cyclo-oxygenase-2 (COX-2) inhibitors, corticosteroids and lack of physical activity and increased incidence of metabolic syndrome in RA.6-8 Systemic inflammatory response in RA is critical to accelerated atherogenesis operating via accentuation of established and novel risk pathways and long term suppression of systemic inflammatory response should be effective in reducing the risk of coronary heart disease.9 This evidence concerns the gene PTGS2 and metabolic syndrome.