Background/Purpose:

Atherosclerotic cardiovascular disease (ASCVD) is the number one cause of death in rheumatoid arthritis (RA) patients. RA itself is an independent risk factor for ASCVD comparable to that of diabetes. Lipid-lowering therapy with statins is one of the most effective drug treatments for primary and secondary ASCVD prevention. The American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines on the treatment of blood cholesterol and the Adult Treatment Panel-III (ATP-III) guidelines differ between their strategies for initiating statins in primary prevention. Carotid ultrasound is a non-invasive tool useful for the detection of subclinical atherosclerosis. Presence of carotid plaque (CP) is an indication of lipid-lowering therapy with statins. The objective of the present study is to compare statin treatment recommendation according to ACC/AHA 2013 guidelines, ATP-III guidelines and CP by carotid ultrasound.

Methods:

An observational, cross-sectional study was designed based on a cohort of RA statin-naïve, 40 to 75 year old, Hispanics that attended a referral center. All fulfilled the 1987 ACR and the 2010 ACR/EULAR classification criteria for RA. Exclusion criteria included overlap syndromes, previous ASCVD (myocardial infarction, stroke and peripheral arterial disease), dyslipidemia, pregnancy, and statin use at baseline. CP was evaluated with B-mode ultrasound and defined as focal thickening at least 50% greater than that of the surrounding wall or carotid intima media-thickness ≥1.2 mm. Multiplication of the scales by 1.5 was performed when applicable according to EULAR cardiovascular risk 2008 recommendations.

Results:

A total of 62 patients were included in the analysis. The patients’ characteristics are shown in Table 1. The mean age was 56.4 ±9.74 years. Women accounted for 55 (88.7%). Mean disease duration in years was 11.46 ±9.73. Statin therapy was recommended by ATP-III guidelines in 8 (12.9%) cases and by ACC/AHA 2013 guidelines in 23 (37.1%) cases. CP by carotid US was identified in 28 (45.2%) patients. McNemar’s test revealed statistical difference in statin therapy recommendation between CP and ATP-III guidelines (p≤0.001), and ACC/AHA and ATP-III guidelines (p≤0.001). No difference was noted between CP and ACC/AHA guidelines (p=0.332).

Conclusion:

In this Hispanic cohort of RA patients, statin treatment recommendation varies among CP and ATP-III guidelines, and ACC/AHA and ATP-III guidelines. No difference was found between CP and ACC/AHA 2013 guidelines. The recent ACC/AHA guidelines may offer better risk assessment for early detection of cardiovascular risk in RA but further prospective studies are needed to evaluate it.