Traditional Cardiovascular Risk-Factor Management in Patients with Rheumatoid Arthritis Compared with Matched Non-Rheumatoid Arthritis Patients in a US Managed Care Setting

J An¹, K Reynolds², E Alemao³, H Kawabata³, D H Solomon⁴, K P Liao⁵ and T C Cheetham², ¹Western University of Health Sciences, Pomona, CA, ²Kaiser Permanente Southern California, Pasadena, CA, ³Bristol-Myers Squibb, Princeton, NJ, ⁴Brigham and Women's Hospital, Boston, MA, ⁵Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, rheumatoid arthritis (RA) and risk management

Session Information

Session Title: Health Services Research: Risk Assessment and Outcomes of Rheumatic Disease

Session Type: Abstract Submissions (ACR)

Background/Purpose: Studies have suggested suboptimal care of traditional cardiovascular risk factors (CRF) in patients (pts) with RA as a reason for elevated CV risk compared with the general population. However, these studies lacked a comparison group, laboratory test results and data on blood pressure (BP) measurements. In this study, we compared CRF management for pts with RA with that of matched non-RA pts within an integrated healthcare delivery system with access to electronic medical records. Methods: Pts aged ≥18 yrs with ≥2 RA diagnoses plus a DMARD were identified as an RA cohort between 01/01/2007 and 12/31/2011 within Kaiser Permanente Southern California. Pts with RA were followed from their first RA diagnosis or prescription date (index). Each pt with RA was matched by age and sex to 4 pts without any RA diagnoses. Non-RA pts were required to have at least one office visit or hospitalization within 12 months from the index date of the matched pair, and the closest encounter date was specified as an index date. Pts without continuous enrollment 12 months prior and post the index date were excluded from the study cohort. Descriptive statistics were used to compare CRF management between RA and non-RA pts. The same analyses were repeated for 1:1 age- and sex-matched osteoarthritis pts as a non-RA group.

Results: A total of 9440 RA and 31,009 matched non-RA pts were included in the study. Mean [SD] age was 56.8 [14.1] for RA and 56.5 [13.9] years for non-RA pts, and 76% were female in both groups. At baseline, 42.9% of RA pts had hypertension, 30.2% had dyslipidemia, 22.9% were obese, and 11.6% were smokers, whereas 32.4% of non-RA pts had hypertension, 35.8% had dyslipidemia, 23.1% were obese, and 10.5% were smokers. Mean [SD] number of office visits during the first yr of follow-up was higher in RA compared with non-RA pts (13.2 [10.8] vs 8.2 [9.1], p<0.001). Rates of BP measurement for treated hypertension and low-density lipoprotein (LDL) cholesterol measurement for treated dyslipidemia were higher in pts with RA compared with non-RA pts (BP: 99.4 vs 91.8%, p<0.001; LDL: 89.6 vs 84.9%, p<0.001). Treatment rates for hypertension were slightly higher in pts with RA compared with non-RA pts (95.0 vs 92.5%, p<0.001) and similar for dyslipidemia (75.1 vs 74.5%, p=0.393). RA pts and non-RA pts had similar rates of BP control but higher rates of LDL and A1C control (BP: 65.2 vs 60.2%, p=0.996; LDL: 65.5 vs 59.7%, p=0.005; A1C: 51.8 vs 42.6%, p<0.001). These results were consistent with results for pts with osteoarthritis as a matched non-RA group.

Conclusion: CRF management in pts with RA was slightly better than the management in non-RA pts in a US managed care setting. The finding of this analysis indicates that the higher CV risk in pts with RA is unlikely to be driven by poor control of traditional CV risk factors.

Figure. Traditional CRF Management for RA and Matched Non-RA Pts

Disclosure:

J. An,

BMS, Genentech, Merck ,

K. Reynolds,
None;

E. Alemao,

Bristol-Myers Squibb,

H. Kawabata,

Bristol-Myers Squibb,

D. H. Solomon,
None;

K. P. Liao,
None;

T. C. Cheetham,

BMS, Gilead,

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