Background/Purpose: Cardiovascular (CV) disease is the leading cause of death in patients with rheumatoid arthritis (RA) and is estimated to be responsible for 29%-32% of all-cause mortality. Meta-analyses of previous cohort studies showed that patients with RA were found to be at 50-60% increased risk of cardiovascular death compared to the general population. Most current American Heart Association (AHA) guidelines place patients with RA as a special population requiring special attention considering it is one of the risk enhancers that prompt physicians to have a lower threshold to initiate statin therapy. The main objective of this study is to evaluate and identify any clinical gaps in the primary prevention of CV risk in patients with RA.

Methods: Data from West Palm Beach VA Medical Center was used to undergo this analysis. All patients from ages 40-79 who had received a diagnosis of RA using the specific ICD09/ICD-10 codes were identified, excluding those with coronary artery disease, cerebrovascular disease or peripheral vascular disease. Data was manually extracted from the Computerized Patient Record System (CPRS), including demographic information (e.g., age, gender and ethnicity), smoking status, vital signs, medical history, active medications, and lipid panel. Patients with an estimated 10-year CV risk of 7.5% or more are determined to be candidates for lipid-lowering therapy.

Results: A total of 317 patients were identified with a mean ± standard deviation (SD) age of 68 ± 8 years, and the majority (77%) were white males. (See Table 1). Three hundred and one (95%) patients had their lipid profile screening test collected in the past 5 years. Out of 165 patients who met the criteria for CVD primary prevention, 68 were on statin therapy (41%). Of which, 48 patients were on a low-intensity statin (71%) despite being candidates for high-intensity statin therapy. Patients on statins were more likely to be older males with diabetes mellites, hypertension, coronary artery disease, or peripheral artery disease, on antiplatelet therapy, and have a higher ASCVD risk score (p-value < 0.05).

Conclusion: Efforts for primary prevention of CV risk in patients with RA are not fully optimized, despite the appropriate screening process for the possible modifiable risk factors. In addition, our study suggests a potential health disparity with regards to prescribing statin in younger and female patients with RA. There is a compelling need for initiating quality improvement projects aimed to improve CV risk control in this particularly vulnerable patient population to improve survival and quality of life.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-management-in-patients-with-rheumatoid-arthritis-a-single-centered-cross-sectional-study/