Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose
Cardiovascular risk (CVR) is increased in RA and should be evaluated annually. EULAR recommends using the SCORE equation to calculate risk, after applying a multiplier of 1.5 in patients with RA who meet two of the following three criteria: disease duration > 10 years, rheumatoid factor or anti-CCP antibody positivity, presence of extra-articular manifestations. European guidelines (ESC) recommend statin therapy for subjects with high or very high risk i.e when CVR calculated with the SCORE equation is ≥ 10% and LDL-cholesterol is ≥ 1.8 mmol/l, or when CVR is > 5% and < 10% and LDL-cholesterol is ≥ 2.5 mmol/l (1,2). Until now the Adult Treatment Panel -III (ATP-III) guidelines recommended the use of statin therapy for primary prevention on the basis of a combined assessment of LDL cholesterol and the 10-year risk of coronary heart disease as calculated with the use of the Framingham risk calculator. American recommendations (ACC/AHA) have recently changed and a new equation to assess overall CVR has been validated. Statin therapy is recommended for subjects aged 40-75 years when CVR is ≥ 7.5.
Assess the need for statin in an established RA cohort (COMEDRA study) according to ESC, ATP-III, and ACC/AHA guidelines with application of the multiplier proposed by EULAR, in patients aged 40 years or older without diabetes, overt cardiovascular disease (CVD) and statins.
Methods
COMEDRA is a multicentre French cohort study of comorbidities in patients with RA and a self-assessment of the disease. At inclusion, general characteristics (age, sex), duration of the disease and treatments for the RA , cardiovascular risk factors (hypertension, diabetes, smoking habit, total, HDL and LDL cholesterol, obesity ), RA activity assessed using the DAS28VS, DAS28CRP, SDAI, CDAI, HAQ, ESR, CRP, RA antibodies were recorded for each patient.
Results
970 patients were included. 612 patients (82.7% women) with established RA (mean disease duration 11.3 [6.5 – 19.8] years) were analyzed (Exclusion age (n = 49); Diabetes or overt CVD (n = 65), statins (n = 168), incomplete data (n = 76)). RA was erosive in 450 (74.3 %) and 484 (79.1%) had positive RF or anti-CCP antibodies. 431 patients (70.4%) were treated with a biologic and 217 (35.6%) received glucocorticoids (mean, 5.34 ± 5.59 mg/day). 90 (14.7%) patients had a family history of early onset CVD, 147 (24.0%) were treated for hypertension, 100 (16.3%) were smokers.
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Treatment recommendations based on Different Guidelines |
|||
|
|
ESC |
ATP-III |
ACC/AHA |
|
Women (n = 506) |
|
|
|
|
Treatment recommended |
7 (1.4) |
50 (9.9) |
155 (30.6) |
|
Treatment considered |
241 (47.6) |
57 (11.2) |
292 (57.7) |
|
No treatment |
257 (50.8) |
399 (78.9) |
59 (11.7) |
|
Men (n = 106) |
|
|
|
|
Treatment recommended |
9 (8.5) |
47 (44.3) |
76 (71.7) |
|
Treatment considered |
80 (75.5) |
21 (19.8) |
29 (27.4) |
|
No treatment |
17 (16) |
38 (35.8) |
1 (0.9) |
Conclusion
In this RA patient’s aged 40 years or older, proportion of individuals eligible for statins differed substantially among the guidelines.
Disclosure:
M. Soubrier,
None;
Z. Tatar,
None;
M. Chevreau,
None;
B. Pereira,
None;
L. Gossec,
None;
P. Gaudin,
None;
M. Dougados,
None.
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