Background/Purpose:   Despite higher risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA), systematic cardiovascular (CV) prevention strategies are lacking. Recent guidelines for CV risk modification rely on documentation of traditional risk factors to estimate 10-year CV risk scores. Our primary objective was to quantify, by utilizing electronic medical records (EMR), the frequency of CV risk factors in a prospective longitudinal RA cohort, as well as use of CV medications, including statins, angiotensin-converting enzyme inhibitors (ACE-i), or angiotensin-receptor blockers (ARB). We also sought to determine the rates of CV risk factors and CV medication use in the subset of RA patients with 2 or more “high risk” disease features, i.e., seropositivity for rheumatoid factor or anti-cyclic citrullinated peptide, disease duration >10 years, or severe extra-articular manifestations (ExRA).

Methods:   Utilizing the EMR, we identified presence of hypertension (HTN), hyperlipidemia (HL), diabetes mellitus (DM), family history, and personal history of CVD, as defined by ICD-9 codes, as well as body mass index (BMI) >30 kg/m² (obesity), uncontrolled HTN (blood pressure [BP] ³150/90 mm Hg for those aged ³60 years; and BP ³140/90 mm Hg for those aged <60 years), and current/ever smoking status. We defined use of any statin, ACE-I, or ARB if listed on EMR’s medications. Severe ExRA was defined by ICD-9 codes for pericarditis, pleuritis, Felty’s syndrome, vasculitis, neuropathy, scleritis/episcleritis, or glomerulonephritis. Merging EMR data with ongoing prospective RA Comparative Effectiveness Research (RACER) database, frequencies were calculated for each of the CV risk factors and medications in a subset of active RACER subjects from enrollment up to October 2013.

Results:   A total of 934 active RACER subjects were identified among 1039 enrolled. Table 1 shows prevalence of CV risk factors. Only 14.7% were taking any statin, 26.3% any ACE-i, and 14.1% any ARB. Out of 675 subjects with complete data, 317 (47.0%) had at least 2 “high-risk” RA disease features that increase their estimated 10-year CV risk score. Of this subgroup, 259 (81.7%) had one or more CV risk factors, yet only 57 (18.0%) were treated with any statin, and 138 (43.5%) were treated with any ACE-i or ARB.

Conclusion:   Among RA patients with available EMR data for traditional CV risk factors, a majority had modifiable obesity, HL and HTN (including uncontrolled). Yet, only a minority were treated with statins, ACE-I, or ARB. These data suggest that CV risk factor management is suboptimal in RA patients, even in the subgroup of RA patients with “high-risk” disease features. The low rates of CV risk factor modification are potential barriers to optimizing CV preventive strategies in RA. Future studies are needed to improve work flows using EMR for CV risk factor documentation and to help modify them in this high-risk population.