Session Type: Abstract Submissions (ACR)
Background/Purpose: Rheumatoid arthritis (RA) is associated with cardiovascular risk (CVR) with an increased prevalence of cardiovascular events and cardiovascular mortality than the general population. Good control of both, the disease activity and cardiovascular risk factors (CVRF), reduces morbidity and mortality associated with this increase in CVR. While control of disease activity is assumed by the rheumatologist, CVRF control could correspond to both the rheumatologist and the family doctor.
Objectives:To evaluate the impact of an initiative to control CVRF in collaboration with family doctors in patients with rheumatoid arthritis.
Methods: RA patients selected consecutively when they came to visit monitoring. For each patient, we collected CVRF (body mass index, smoking, blood pressure, serum glucose, total cholesterol, LDL cholesterol and triglycerides) and calculated the SCORE and the SCORE modified. The patient was informed of the need to correct their CVRF and handed a letter to your family doctor reported in which the importance of control of cardiovascular risk factors in patients with RA and were asked for their cooperation in controlling thereof. In addition, you specify the therapeutic objective to achieve respect to LDL cholesterol: 1.7 nmol / L (70 mg / dL) in patients with high CVR (SCOREm ≥ 5%) or suffered a cardiovascular event and 2.5 nmol / L (100mg/dL) in the rest. In the next view of control, there was whether there had been any intervention, and if he had achieved the therapeutic goal.
Results: We included 211 patients (171 (81%) women) with a mean age of 60 ± 12 years and a duration of RA of 13 ± 9 years. FR was 72% and 70% + PCC +. 70% of patients were treated with glucocorticoids, 86% and 32% FAME with biological treatment. For DAS28 criteria, 71% had low activity, 27%, moderate and 2%, high activity. On a visit home, 25% of patients were overweight, 17% smoked, 51% were hypertensive, 6% were hyperglycemic, 53% had a serum total cholesterol> 5.2 mmol / L ( 200 mg / dL), and 23% were hipertrigliceridémico. The 5% had no cardiovascular risk factors, 20% had one, 34% two, 28% three, and 13%, more than three. The goal LDL was 1.7 in 29% of patients. There were new diagnoses of CVRF in 100 patients (47%): 1 diabetes, 18 hypertension, 82 with elevated LDL cholesterol and 27 hypertriglyceridemia. The family physician changed the treatment in 2/12 diabetes, 30/84 HTA, 74/167 with elevated LDL cholesterol and 21/51 hypertriglyceridemia in which the change was indicated. The end result of the intervention was that between the two visits, the percentage of patients with CRF who had good control over it happened: a) in diabetes, from 48% to 44%, b) in hypertension, 25% to 73% c) elevation of LDL cholesterol from 10 to 17%, and d) in hypertriglyceridemia, 25% to 38%.
Conclusion: Through the intervention has been diagnosed at least a new CVRF not known in a high percentage of patients. The response of family physicians as measured by the change in drug regimen is considered insufficient. As a result, control of cardiovascular risk factors, and mainly of dyslipidemia is suboptimal.
A. Zacarias Crovato,
J. M. Nolla,
C. Gomez Vaquero,
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-initiative-to-control-cardiovascular-risk-factors-in-collaboration-with-local-doctors-in-patients-with-rheumatoid-arthritis/