Background/Purpose: Cardiovascular disease (CVD) is the leading cause of death in individuals with rheumatoid arthritis (RA). Patients with RA are at 1.5-2.0-fold increased risk of CVD morbidity relative to the general population.  Despite the high burden of CVD and recommendations by the European League Against Rheumatism (EULAR) for routine cardiovascular risk assessment and management, it has recently been shown that both rheumatologists and primary care physicians identify and manage cardiovascular risk factors less often in RA patients compared with controls from the general population.

Methods: We queried our electronic health record (EHR) using Structured Query Language and used an accurate RA detection algorithm.  We assessed whether patients had established CVD, and collected data for cholesterol, blood pressure, antihypertensive and lipid lowering therapy, and smoking and diabetes status.  We calculated CVD risk (symptomatic coronary or cerebrovascular disease) using equations from the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) risk assessment guideline.  We identified RA patients with a CVD risk of ≥ 5% because at this level the ACC/AHA guideline recommends statin therapy be considered, and strongly recommends it at a level of ≥ 7.5%.  In addition, RA patients with CVD risk estimated at 5% likely have a true level of risk exceeding 7.5% because CVD risk is increased approximately 1.5 fold in RA.

Results:   Among 1414 RA patients, 83% were female and mean age was 56 years.  Only half of RA patients had all major risk factors assessed (data missing for lipids [49%] and diabetes screening [8%]). Among those potentially eligible for a statin (known CVD or 10-year CVD risk of ≥ 5%), only 47% were treated with a moderate or high intensity statin and 46% were prescribed no statin.  Most recent BP was <140/90 for 83% of the cohort.  Diabetes and current smoking prevalences were low (9.9% and 5.3% respectively).

Conclusion: In this academic rheumatology practice, we found two major areas for CVD prevention improvement:  promotion of complete risk factor assessment and the appropriate use of statins. This study demonstrates that system-based interventions are needed to improve CVD risk factor assessment and management among RA patients in this practice.  Such interventions might include both rheumatology and generalist provider education, performance feedback, and point of care decision support tools within the rheumatology practice to improve risk factor measurement and referral for risk factor modification.  

Table 1. Atherosclerotic Cardiovascular Disease (ASCVD) Risk Factors and Treatment among Study Site RA Patients*

*Bolded numbers indicate populations with potential targets for clinical intervention.  Abbreviations:  LDL, low density lipoprotein, HbA1c, hemoglobin A1c.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-unassessed-and-uncontrolled-cardiovascular-disease-risk-factors-among-rheumatoid-arthritis-patients-in-an-academic-rheumatology-practice/