Background/Purpose:

The increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) has been well established. While the reasons for an increased risk of CVD in RA remain unclear, it is imperative to carefully manage cardiovascular risk factors in RA patients. The purpose of this study was to compare CVD risk management in seropositive RA patients compared with non-RA patients in a large healthcare system.

Methods:

The study design was a matched retrospective cohort comparing subjects with seropositive RA and non-RA patients drawn from the outpatient population receiving care within the Fairview Health System in Minnesota between 1/1/2005 and 12/31/2015. A cohort of 732 adult subjects with seropositive RA was identified from electronic medical records, and matched with a cohort of 2994 non-RA patients based on age and sex. Demographic characteristics and multiple clinical measures of cardiovascular risk, including BMI, outpatient blood pressure, smoking status, serum lipids and hemoglobin a1c, were ascertained from electronic medical record. Mortality was assessed from medical and state records.Chi-square tests were used for categorical variables and t-tests or Wilcoxon-Mann-Whitney tests for continuous variables. Generalized estimating equation models were used for longitudinal analyses.

Results:

The mean age at baseline was 56 years in both RA and non-RA cohorts, and the majority of patients were female (79% RA, 80% non-RA). Participants in the two cohorts were largely white (82% RA, 85% non-RA), and overweight or obese (baseline BMIs of 25 or greater in 69% RA, and 71% non-RA patients). RA patients, on average, lived in zip codes with a lower median household income than non-RA patients (65,100 vs 67,700, p<0.01). Patients had a minimum of one year follow up (mean 6 years RA, 5.7 years non-RA). There were more deaths in the RA cohort than non-RA cohort during the follow-up period (15% vs 10%, p<0.01). RA patients and non-RA patients, on average, had blood pressure readings, cholesterol and A1C measurements in the normal range, and there was no difference in these parameters between cohorts in longitudinal analyses. Mean systolic blood pressure was 125 and mean diastolic blood pressure was 73 in both RA and no-RA patients. Mean HDL, LDL, Total cholesterol, and A1C were 55±1, 104±2, 188±2, and 6.7±0.1, respectively, for RA patients and 53±0.4, 103±1, 183±1, and 6.9±0.05 for non-RA patients. However, there was a higher percentage of current smokers among RA patients (24% vs. 14%, p<0.01).

Conclusion:

While most CVD risk factors were well managed in seropositive RA patients and in non-RA controls, we found an excess of active smoking in RA patients compared with the non-RA cohort, indicating an area of potential practice improvement.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-management-in-seropositive-rheumatoid-arthritis-what-can-we-do-better/