Background/Purpose: EULAR recommendations for cardiovascular disease (CVD) risk management in inflammatory joint diseases (IJD) advocates annual CVD risk assessments to reduce the increased CVD risk. Knowledge of the prevalent CVD risk factors in different diagnoses may enable tailoring of efficient CVD preventive strategies. Our aims were: I) Evaluate prevalence of CVD risk factors in IJD patients and 10-year risk for fatal CVD according to the systemic coronary risk evaluation (SCORE). II) Investigate CVD risk factor distribution across IJD entities and age groups.

Methods: In the nationwide NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) project, annual CVD risk assessment is implemented. IJD patients ≥30 years of age are eligible for inclusion. Recorded CVD risk factors include non-fasting lipids, blood pressure (BP), self-reported CVD risk variables and established CVD. SCORE estimates were compared across IJD diagnoses for males and females individually, using analysis of variance, stratified by decennial age. Number of CVD risk factors, determined by presence of diabetes, hypertension, family history of premature CVD, hyperlipidemia (total cholesterol >8 mmol/L and/or low-density lipoprotein cholesterol> 6 mmol/L), current smoking or obesity (body mass index>30kg/m²), was counted for each patient. Frequency of CVD risk factors for was estimated and compared across the four major entities, using logistic regression (age and sex adjusted).

Results: Of 2647 patients included (rheumatoid arthritis [RA]: n=1696, ankylosing spondylitis [AS]: n=445, psoriatic arthritis [PsA]: n=376 and other spondyloarthritides [SpA]: n=130), 58% were females and the median (inter-quartile range [IQR]) age and disease duration were 57.4 (46.8-66.8) and 8.0 (3.8-15.9) years, respectively. Median (IQR) crude SCORE estimate was 2.2% (0.5-4.3) and comparable across diagnoses, apart from male AS patients having lower SCORE estimates (p=0.01). CVD risk factor prevalence were comparable across individual IJD diagnoses, except PsA patients who had significantly (p=0.01) more CVD risk factors in the oldest age groups.The percentage with at least one CVD risk factor and mean number of risk factors was 45 % and 0.6 in individuals < 40 years, increasing to 66% and 1.1 and 84% and 1.5 in age groups 40-60 and >60 years, respectively (Figure). In detail, CVD risk factor rates were: family history of premature CVD: 18%, established CVD: 10%, current smoking: 20%, hypertension: 53%, obesity: 18%, diabetes: 7%, hyperlipidemia: 1%. PsA patients were significantly more likely to be obese (p=0.001), hyperlipidemics (p<0.05), diabetics (p<0.001), hypertensive (p<0.0001), and were less frequently smokers (p=0.04).

Conclusion: A high rate of CVD risk factors was present even in young patients. Apart from PsA, the prevalence of CVD risk factors was uniformly distributed across all IJD entities.