Background/Purpose:

Patients with inflammatory arthritis are at increased risk for atherosclerotic cardiovascular (CV) disease. This has been under-recognized in clinical practice. Additionally, the current risk stratification methods underestimate risk in this population.

The purpose of our study was to describe the population characteristics of patients attending a Cardio-Rheumatology Clinic, a new collaborative initiative at a large academic medical centre in Canada, which aims to improve CV care of patients with inflammatory arthritis, and to report changes in treatments for CV prevention initiated during their clinic visit.

Methods:

This study is a cross sectional analysis of patients assessed in the Cardio-Rheumatology Clinic from July 2017 to May 2018. Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) with no known CV disease were referred to the clinic. Information about their rheumatic disease, lifestyle habits, medications and co-morbidities was recorded. Each patient was evaluated by a cardiologist focusing on CV risk assessment. All patients underwent blood tests for lipids and cardiac biomarkers, electrocardiogram, coronary artery calcium scoring, stress echocardiography and carotid ultrasound.

Results:

95 patients with RA (49.5%), PsA (38.9%) and AS (11.6%) were evaluated (mean age 59.5 years, 67.4% female). Hypertension was reported in 31.6%, dyslipidemia in 26.3%, diabetes mellitus in 8.4% and family history of premature CVD in 30.1%. History of current smoking was present in 10.2%. Sedentary lifestyle was common; only 20% of patients reported 3 hours or more of vigorous exercise per week and functional capacity was rated as below average for age and sex in 31.8%, and 72.3% were overweight or obese. Tables 1 summarizes the CV risk factors and laboratory findings and Table 2 describes key CV abnormalities in imaging. Importantly, 53.8% of patients had a change in pharmacological therapy as a result of evaluation in the clinic, including 39.7% for lipid lowering, 32.1% for antiplatelet, 14% for antihypertensive therapy, 1.3% were treated for heart failure and 1.3% were placed on lifelong anticoagulation therapy for atrial fibrillation. One patient underwent percutaneous coronary stenting.

Conclusion:

A dedicated Cardio-Rheumatology Clinic has led to identification of increased CV risk, early atherosclerosis and optimization of CV care in a large proportion of our clinic population. Further work in this area is needed to help raise awareness of this increased risk and to help develop more accurate tools to assess CV risk in this population.