Background/Purpose: Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease affecting one percent of the population.  The main cause of mortality among RA patients is cardiovascular disease (CVD), which occurs on average 10 years earlier than in the general population. Even when traditional risk factors such as hypertension, tobacco use, diabetes, and dyslipidemia are accounted for, there is still an elevated CVD risk associated with having RA that may be partly due to systemic inflammation from RA. Many rheumatologists routinely recommended that primary care providers (PCPs) follow the established guidelines for high risk cardiovascular patients in terms of modifiable CVD risk factors when treating RA patients.  In this study we are comparing modifiable risk factor control in RA patients to high risk CVD patients.

Methods: Retrospective data was collected from the year 2013 in rheumatology, internal medicine, family medicine, and cardiovascular medicine clinics. ICD-9 codes were defined for patient selection: 1) RA without other CVD codes as the RA group, and 2) the CVD group which included one or more of myocardial infarction, diabetes, peripheral vascular disease, and coronary atherosclerotic disease without an RA code. Demographics including age and sex as well as modifiable CVD risk factors including systolic and diastolic blood pressure (BP), body mass index (BMI), smoking status, and lipid panel including total cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides (TG) were collected. RA patients were then compared to high risk CVD patients in terms of these modifiable risk factors.

Results: The CVD group was on average older, smoked more, and had an equal gender ratio. BMI was lower in the RA group (Table 1).  Systolic BP was similar in the two groups, though diastolic BP was slightly higher in the RA patients (Table 1). As expected, many RA patients had missing cholesterol data presumably because they received screening studies through their primary care provider outside of the university system. However, in the RA patient subgroup with available lipid data, analyses showed that RA patients had significantly higher mean total cholesterol, HDL, and LDL, while CVD patients had higher triglycerides (Table 1).

Conclusion: Despite an emerging body of evidence that RA patients should be treated as high risk CVD patients in terms of modifiable CVD risk factors, RA patients in our study had reasonable BP control but did not meet most lipid goals. Opportunities for improvement are numerous, starting with patient and provider education and increasing  the frequency of PCP visits. Our future studies will examine the same cohort longitudinally and evaluate the rate of cardiovascular events. We also plan to study PCP attitudes towards RA patients and CVD risk, as well as on CVD risk factor control.

TABLE 1: Modifiable CVD Risk Factors

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/control-of-modifiable-cardiovascular-risk-factors-in-rheumatoid-arthritis-patients-compared-to-traditional-high-risk-cardiovascular-disease-patients/