Background/Purpose : The relative risk of acute myocardial infarction in RA patients (pts) has been shown to range from 1.5 to 2.0, with a 1.4–2.7-fold higher risk of stroke. This study aimed to compare management of traditional cardiovascular (CV) risk factors such as lipids and blood pressure in pts with and without RA.

Methods : A retrospective cohort study was conducted from 1987 to 2010, using the GOLD database from the Clinical Practice Research Datalink. Pts presenting with ≥1 RA read diagnosis code after January 1 1988 (index code), with no RA or juvenile RA codes before the RA index code with ≥12 months of data reported before the first RA code, and without any psoriatic arthritis-related codes over the entire period were included. Pts with RA were matched 1:4 to non-RA pts, based on their year of entry in the database, CV risk category (National Cholesterol Education Program classification), CV treatment status and a risk score measuring the probability of having RA. The index code of non-RA pts was defined as the closest health encounter to the index code of their match. Prescriptions for antidyslipidemic, hypertensive and diabetic treatments were evaluated for up to 5 years post index code. The percentage of pts attaining UK CV targets was also evaluated.

Results : Between 1987 and 2010, 24,859 RA pts were identified and matched to 87,304 non-RA pts. RA pts were followed for an average (SD) of 5.8 (4.4) years, were 60.0 (15.1) years old; 69% were female, 39% were hypertensive and 27% dyslipidemic at index date, based on diagnoses, prescriptions and tests. Similarly, non-RA pts were followed for an average of 5.7 (4.4) years, were 60.2 (15.9) years old; 66% were females, 38% hypertensive and 28% dyslipidemic. The percentage of RA pts prescribed antihypertensives increased from 38.2% at diagnosis to 45.7% at 5 years, from 14.0% to 20.6% for antidyslipidemics, and from 5.1% to 6.4% for antidiabetics (Table). Index rates and changes over time were similar in non-RA pts, although slightly lower for antihypertensives. There was no difference between RA and non-RA pts reaching hypertension targets at 1 year (25.8% vs 26.9%, p=0.50) although there was for dyslipidemia and diabetes (16.4% vs 18.5%, p<0.01; and 48.7% vs 44.3%, p<0.01, respectively). Blood pressure, lipids and diabetes-related testing were similar in both groups over time since diagnosis, although CRP and ESR were higher in RA pts at diagnosis (24.6 mg/L and 31.9 mm/hr, respectively), decreasing over time. These values were lower and did not vary over time in non-RA pts.

Conclusion : There were no differences between RA and non-RA patients in the frequency of prescriptions and testing, although there was a modest 2% lower achievement in lipid targets. Based on this analysis, it seems the higher CV risk in RA patients is unlikely to be driven by differences in traditional CV risk factor management alone.