Background/Purpose: Meta-analyses of observational studies showed that RA patients’ morbidity and mortality risks stemming from cardiovascular (CV) causes were, respectively, close to 50% and 60% higher than those of the general population. It has been proposed that high-grade inflammation affects multiple tissues and leads to endothelial dysfunction, dyslipidemia, more oxidative stress, increased levels of homocysteine, and insulin resistance. These effects accelerate atherogenesis and myocardial microvascular abnormalities. Research has shown that the tools used for risk assessment in the general population underestimate the true risk when they are applied to patients with proatherogenic diseases such as diabetes mellitus (DM) or chronic kidney disease (CKD). Evidence suggests that this is also the case with RA.

Methods: We reviewed the electronic medical records (EMR) of patients with the diagnosis of RA based on the ICD 9 codes, that were followed at the University of Virginia Rheumatology outpatient clinic in the 7/2014 – 5/2015 period. We reviewed age, gender, RF/CCP positivity, disease duration of more than 10 years, current smoking status, systolic blood pressure (SBP) and treatment, lipid panel (date, total cholesterol, HDL, LDL), cholesterol medications, DM status, aspirin use. We calculated the cardiovascular risk by multiplying the Framingham risk score by 1.5 as per EULAR recommendations.

Results: A total of 460 charts were reviewed. 78% of patients were female and 22% were male. 44.56% had lipid levels available in the EMR. Of the patients with documented lipid levels 49.75% had levels checked more than 2 years ago. Only 22.39% of the total patients reviewed had recent lipid levels documented in the EMR (less than 2 years old). Of the 359 female patients, 28.91% were on cholesterol medications although 60.84% had an LDL level greater than 100. 15.32% were smokers, 14.2% had a diagnosis of DM, while 29.24% had an SBP of more than 140. Of the 101 male patients, 56.41% were on cholesterol medications and 43.58% had an LDL level greater than 100. 22.77% were smokers, 19.8% had a diagnosis of DM, and 29.7% had an SBP of more than 140. Our data for female patients shows that the Framingham risk score is higher than the average population in all age groups except for the 55 – 64 years old age group and significantly higher in all age groups when multiplied by 1.5. Our data for male patients shows that the Framingham risk score is higher than the average population in all age groups except for the 60-69 years old age group and significantly higher in all age groups when multiplied by 1.5.

Conclusion: Studies have shown that RA patients have an increased cardiovascular risk, similar to DM and CKD population and twice as high as the general population. Our chart review shows that our RA patients have a number of CV risk factors and have an increased risk compared to the normal population based on calculated Framingham risk score as well as multiplication for RA. Additionally it appears that lipid screening and aggressive treatment for hypertension is underutilized in this population. We propose to send letters to the primary care practitioners to increase awareness of the CV risk assessment in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-and-lipid-screening-in-rheumatoid-arthritis-patients-in-a-university-rheumatology-practice-quality-improvement-project/