Background/Purpose: Cardiovascular mortality is increased
in rheumatoid arthritis
(RA) and RA is an independent
risk factor leading to a rapid increase in risk following diagnosis. Reduction of LDL-cholesterol (LDL-c) is essential
to decrease CV risk.  Between 2005 and
2010, French recommendations were
based on the serum level of LDL-c, the target LDL-c depending on the number of risk factors. In
2006, it was recommended to consider RA as an additional cardiovascular risk factor (1). Our objective was
to assess every year between 2005 and 2010 the
proportion of patients with recent-onset
RA achieving LDL-c objectives of national guidelines.

Methods : ESPOIR is a
large, French, multicenter cohort
of patients with early arthritis of less than 6 months‘ duration and a
high probability of developing
RA. 814 patients were included
between 2002 and 2005. Repeated
cross-sectional analysis
for cardiovascular risk factors, LDL and HDL cholesterol levels were performed
every year between 2005 and 2010 to determine
the proportion of patients achieving the LDL-c goal according to the French guidelines considering
RA as an additional risk
factor since 2006.

Results : 689 patients were
analyzed at the first point (age
49.6 ± 12.2 years, mean symptom duration was 1.83 ± 0.95 years), 77 % were female. At this first point, 495
patients  (72 %) fulfilled
the ACR criteria for RA. 3 % of the patients were being treated
with statins which  did not significantly vary during follow-up.
The proportion of patients achieving the recommended LDL-c target decreased significantly following the publication of specific
RA guidelines in 2006 but did
not differ during the next 5 years of follow-up (89.5 % in 2005 ;
84.7 % in 2006 ; 81.5 % in
2007 ; 77.5 % in 2008 ; 80.6 % in 2009, 81.5 % in 2010). More
males and more than half of
patients with high CV risk did not reach the lipid target. The proportion of
patients who did not achieve the LDLc target increased with the number of risk factors accounting
for less than  8 % in patients with
only one risk factor and
for more than 58 % in patients with
the highest risk (Table).

Conclusion: Regardless of specific recommendations for
management of cardiovascular risk
in RA patients and large cholesterol screening,
management of dyslipidaemia remained
suboptimal in particular among patients at highest risk.  It is still unclear
whether the expansion of the indications for statin therapy would expand lipid
target achievement.

1.     
Pham
T, Gossec L, Constantin A et
al. Cardiovascular risk and rheumatoid arthritis: clinical practice guidelines
based on published evidence and expert opinion. Joint Bone Spine.
2006;73:379-87

 Proportion of patients in whom LDLc
target was NOT achieved according to the level of cardiovascular risk.