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THU0129 Unavoidable and modifiable risk factors for ischaemic heart disease (IHD) in rheumatoid arthritis (RA)
  1. NX Erb1,
  2. MJ Banks1,
  3. IF Rowe2,
  4. GD Kitas1
  1. 1Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley
  2. 2The High Field Rheumatology Unit, Worcestershire Acute Hospitals NHS Trust, Worcester, UK

Abstract

Background IHD is the commonest single cause of death in RA.1 Having RA is an independent risk factor for the development of IHD.2 Classical risk factors are also important, contributing a baseline risk as they do in the general population. The baseline risk can be calculated using general population data,3 and its modifiable component may be an important therapeutic target in RA.

Objectives To identify the absolute baseline risk in a hospital RA population, determine its modifiable and non-modifiable components, and assess the relative contribution of each of the modifiable risk factors.

Methods 63 random hospital outpatients with RA (40 females, 23 males, age: 59.75 (10.58) years) were assessed using the Cardiac Risk Analysis Body Manager Version 1.24 Software. Absolute risk value was calculated for each individual; this was subdivided into modifiable risk (calculated from weight, systolic BP, total cholesterol, smoking and exercise habits) and non-modifiable risk (calculated from gender, age and family history of IHD).

Results Total population mean (SD): Systolic BP: 145.95(22.54) mmHg; Total Cholesterol: 5.73(1.01) mmol/l; BMI: 28.12(4.07); smokers: 19.05% [male: 21.74% vs. female 17.5%; p < 0.01]. 22.2% of patients (males >females, p < 0.05) were at high absolute risk, 68.3% at moderate risk and 10% at average or low risk of having a major cardiovascular event in the next 6–8 years. The mean absolute risk for the group was moderate 30.89(5.03)%. Most of the absolute risk was modifiable [60.89(9.83)%] the remaining 39.17(9.78)% being non-modifiable. The largest contributors to the modifiable component were exercise 36.68(9.28)% and weight 24.24(9.68)%; Systolic BP, total cholesterol and smoking contributed much less [18.44(7.61)%, 16.32(10.34)%, and 4.02(9.42)% respectively].

Conclusion 90% of hospital RA patients have a moderate or high baseline cardiovascular risk to develop a major event in the next 6–8 years. Two thirds of this risk is modifiable, and two thirds of the modifiable component is due to reduced exercise and increased weight. We suggest that all RA patients should have their classical IHD risk factors assessed and appropriately targeted in the routine clinical setting.

References

  1. Wolfe F, Mitchell DM, Sibley JT, et al. The mortality of rheumatoid arthritis. Arthritis Rheum. 1994;37:481–94

  2. Banks M, Flint J, Bacon PA, Kitas GD. Rheumatoid arthritis is an independent risk factor ischaemic heart disease. Arthritis Rheum. 2000;43(9):S385

  3. Liao Y, McGee DL, Cooper RS, Sutkowski MB. How generalizable are coronary risk prediction models? Comparison of Framingham and two national cohorts. Am Heart J. 1999;137:837–45

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