Background/Purpose:

Cardiovascular (CV) risk is higher among rheumatic disease patients than the general population.  However, CV risk management guidelines calibrated for the rheumatic disease population do not currently exist.  At our academic medical center, we recently established an interdisciplinary Cardiovascular Rheumatology clinic aimed at optimizing CV care.  The objective of this study was to characterize and quantify the change in management recommended for rheumatic disease patients after formal evaluation by cardiologists.

Methods:

We studied patients referred to the CV Rheumatology clinic for cardiovascular risk assessment from January 2012 when the clinic began to April 2013.  The clinic is held once a month in the rheumatology clinic with patients referred from the rheumatology practice, staffed by 3 board certified cardiologists.  Patient demographic information was obtained from the medical record.  CV risk factors and change in management was assessed by manual chart review of cardiologists’ notes.  The following were considered changes in management: (1) change in medication therapy (defined as starting, increasing dose, or switching CV related medications); or (2) further work-up to assess risk (e.g. further laboratory studies to stratify CV risk, stress testing or referral to a cardiac subspecialty).  The Adult Treatment Panel III (ATP III) Guidelines were applied to the subset of subjects who were recommended to start or increase statin dose.  The ATP III Guidelines specifies low density lipoprotein (LDL) goal levels for patients based on number of traditional CV risk factors and 10 year risk for heart disease according to the Framingham Risk Score. 

Results:

We studied 31 patients referred for CV risk assessment.  The mean age was 57 yrs and 77% were female.  The most common underlying rheumatic diseases in the CVR clinic were RA (38.7%) and SLE (25.8%).  Hypertension (51.6%) was the most prevalent CV risk factor at presentation, followed by hyperlipidemia (45.2%).  Of the patients seen, 83.9% were recommended a change in their current CV management.  The most commonly recommended change or intervention was starting or increasing statin therapy (35.5%), change in anti-HTN therapy (16.1%) or stress testing (12.9%).  Among the subjects recommended to start or intensify statin therapy, 63.6% would have been considered already at target LDL according to ATP III Guidelines. 

Conclusion:

We observed that the majority of rheumatic disease patients referred to the CV Rheumatology clinic had a change in CV risk management after evaluation by a cardiologist.   Recommended LDL targets by cardiologists at our center were lower than ATP III guidelines, leading to intensification of statin therapy.  These data suggest a need for CV risk management optimization in patients with rheumatic diseases.

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« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/quantifying-the-gap-between-general-population-guidelines-and-expert-opinion-for-cardiovascular-risk-management-in-rheumatic-disease-patients/