Background/Purpose: Rheumatoid arthritis (RA) is associated with a 1.5 to 2 fold increased risk of cardiovascular disease (CVD) due to systemic inflammation and endothelial dysfunction. This level of cardiovascular threat is comparable to––and may even exceed––that of traditional risk factors such as diabetes. The European Alliance of Associations for Rheumatology (EULAR) recommends adjusting CVD risk scores by a factor of 1.5 in patients with RA, emphasizing the importance of cardiovascular risk screening in this population, including lipid testing. The American College of Cardiology (ACC) and American Heart Association (AHA) recommend lipid screening every 4 to 6 years in all adults, and as often as every 2 years when risk factors are present. In this study, we aimed to assess the prevalence and patterns of lipid screening in RA patients.

Methods: We conducted a retrospective cohort study using electronic health records from a large academic health system. Adults (≥18 years) with RA who had at least one outpatient rheumatology visit between 1/1/2020 and 12/31/2024 were included. Lipid screening was defined as any recorded lipid panel over the five year period. Relevant demographic and clinical factors were extracted, including age, sex, BMI, and comorbidities. Chi-squared tests were then used to compare the rates of lipid screening across different subgroups.

Results: We analyzed 1,686 patients with RA, of whom 81.7% were female and 18.3% were male. Overall, 1,182 patients (70.1%) underwent lipid screening over the 5-year period, while 504 (29.9%) did not. Screening rates were significantly higher among patients with traditional cardiovascular risk factors. RA patients with diabetes were more likely to be screened than those without (77% vs. 60%, p< 0.0001), as were those with hypertension (77% vs. 60%, p< 0.0001). Screening was also more common among patients with obesity (BMI ≥30) compared to those with lower BMIs (76% vs. 72%, p=0.03). Patients under 40 were less likely to be screened than middle-aged or older patients (45% vs. 72%, p< 0.0001).

Conclusion: Despite the well-established cardiovascular risk, nearly one in three RA patients in our health system did not undergo lipid screening over a 5-year period. When screening did occur, it was more strongly associated with the presence of traditional risk factors, including hypertension, diabetes, and obesity, than with RA alone. This suggests that clinicians may not fully recognize RA itself as an independent driver of cardiovascular risk, leading to missed opportunities for disease prevention. To address this gap, our health system is implementing an Epic Best Practice Alert (BPA) to prompt regular lipid testing in all RA patients. Through such tools, we aim to facilitate earlier risk management and ultimately reduce cardiovascular morbidity and mortality in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lipid-screening-in-rheumatoid-arthritis-a-retrospective-cohort-study-highlighting-gaps-in-cardiovascular-risk-prevention/