Background/Purpose: Patients with inflammatory joint disease, including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) carry increased risk of cardiovascular disease (CVD). Mechanisms underlying this increased risk are thought to be attributable to a combination of traditional and novel CVD risk factors (engaged pathogenic inflammatory pathways). Lipid lowering statin therapy is one of the most commonly used CVD preventive medications. We explored statin use patterns in patients with inflammatory joint disease (RA, PsA and AS) accounting for traditional CVD risk factors. 

Methods: This was a retrospective chart review study conducted at the Cleveland VA Medical Center. ICD 10 diagnoses for RA, AS and PsA identified local populations of these patients. Medical charts of 200 RA (all seropositive for either RF or CCP in this sample set), 41 AS, 94 PsA and 19 patients with no inflammatory joint disease (general medical clinic patients) were reviewed. Diagnoses were verified using rheumatology clinic visit information and ACR, ASAS, or CASPAR criteria. Records were reviewed for ASCVD risk score components (age, gender, race, presence of hypertension or diabetes, lipid profile, and smoking status). We examined patient race, body mass index (BMI), and treatment history. When calculating ASCVD Risk Score, if age or lipid levels were above or below the limitations of the calculator, either the upper or lower limit values were used, respectively.

Results: Clinical characteristics are shown in Table 1. Most of the patients were male, consistent with the VA patient population. Patients with RA had higher ASCVD scores compared to patients with AS and PsA. In the subgroups with ASCVD score above or equal to 7.5, RA and PsA patients more commonly had diabetes mellitus, while RA patients were older and more commonly had hypertension. Only 51.8% of RA, 37% of AS and 68% or PsA patients with ASCVD score at or above 7.5 were prescribed statin compared to 81.8% of patients with no inflammatory joint disease (p=0.06). Chart review for reasons patients were not on statin included: 1) undergoing a trial of dietary change and weight loss; 2) patient declining recommended medication; and 3) other.

Conclusion: Patients with inflammatory joint disease and traditional CVD risk factor with indication for statin may benefit of provider education and improvement of CVD risk assessment and initiation of proper preventive measures in these high risk inflammatory joint disease patient populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/statin-use-pattern-in-patients-with-inflammatory-joint-disease-in-a-single-site-va-medical-center/