Background/Purpose

More than 50% of premature deaths in patients with rheumatoid arthritis (RA) are due to cardiovascular disease (CVD). Both the cumulative burden of inflammation and the increased prevalence of conventional CVD risk factors contribute to this increase in CVD. CVD risk screening and management is therefore mandatory.¹

Methods

A cross-sectional study was conducted to screen RA patients for CVD risk factors at rheumatology outpatient centers in Germany. Age, gender, smoking habits, blood pressure, and lipid levels were assessed, as well as medications, comorbidities, DAS28, CVD, and standard laboratory parameters. Using these parameters, a subset of patients was assigned to 3 high-risk CVD subgroups: patients with manifest CVD, patients with diabetes mellitus (DM; type 1 or 2), and, as the CVD mortality risk is a function of age, patients ≥70 years of age. Achievement of target values for CVD risk factors adopted from the European Society of Cardiology (ESC) and European League Against Rheumatism (EULAR) recommendations were compared within these groups.^1,2 Descriptive data analysis was performed without adjusting for confounders. The RA population without those risks was used as a comparator group and stratified into risk categories by the mSCORE model.²

Results

The comparator population included 866 patients with RA. High-risk subgroups included 146 RA patients with existing CVD, 111 RA patients with DM (28 aged ≥70 years) and 114 RA patients aged ≥70 years but without DM or CVD. 49% of the CVD patients had a previous myocardial infarction or stroke, 62% had coronary heart disease (CHD), and 22% had previous arterial occlusion events. Recommended target values for CVD risk factors were not achieved by a substantial number of patients even in the high risk populations. Depending on the subgroup, 40%–45% of the patients achieved low disease activity or DAS remission, 41%–63% reached the respective blood pressure target, and 0%–28% reached the low-density lipoprotein (LDL) cholesterol target (Table 1). Lipid target values were rarely achieved in high-risk populations. Only a minor fraction of patients received statin therapy; there was no difference in glucocorticoid use between the high-risk and comparator populations. 65% of the investigators stated that the EULAR recommendations for the management of CVD risk in RA influenced their diagnostic and therapeutic concept.

Conclusion

Target values for CVD risk factors are rarely achieved in high-risk RA patients in routine outpatient settings, reflecting the insufficient management of CVD risk.

References

1. Peters MJL, et al. Ann Rheum Dis. 2010;69:325-331. 2. Perk J, et al. Eur Heart J. 2012;33:1635-1701.