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Statin use in rheumatoid arthritis in relation to actual cardiovascular risk: evidence for substantial undertreatment of lipid-associated cardiovascular risk?
  1. Tracey E Toms1,
  2. Vasileios F Panoulas1,
  3. Karen M J Douglas1,
  4. Helen Griffiths2,
  5. Naveed Sattar3,
  6. Jaqueline P Smith4,
  7. Deborah P M Symmons5,
  8. Peter Nightingale6,
  9. George S Metsios1,
  10. George D Kitas1,5
  1. 1Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK
  2. 2Life and Health Sciences, Aston University, Birmingham, UK
  3. 3University of Glasgow, Glasgow, Scotland, UK
  4. 4Department of Clinical Biochemistry, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK
  5. 5arc Epidemiology Unit, Manchester University, Manchester, UK
  6. 6Wolfson Computer Laboratory, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Professor George D Kitas, Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK; gd.kitas{at}dgoh.nhs.uk or g.d.kitas{at}bham.ac.uk

Abstract

Background Cardiovascular disease (CVD) is partially attributed to traditional cardiovascular risk factors, which can be identified and managed based on risk stratification algorithms (Framingham Risk Score, National Cholesterol Education Program, Systematic Cardiovascular Risk Evaluation and Reynolds Risk Score). We aimed to (a) identify the proportion of at risk patients with rheumatoid arthritis (RA) requiring statin therapy identified by conventional risk calculators, and (b) assess whether patients at risk were receiving statins.

Methods Patients at high CVD risk (excluding patients with established CVD or diabetes) were identified from a cohort of 400 well characterised patients with RA, by applying risk calculators with or without a ×1.5 multiplier in specific patient subgroups. Actual statin use versus numbers eligible for statins was also calculated.

Results The percentage of patients identified as being at risk ranged significantly depending on the method, from 1.6% (for 20% threshold global CVD risk) to 15.5% (for CVD and cerebrovascular morbidity and mortality) to 21.8% (for 10% global CVD risk) and 25.9% (for 5% CVD mortality), with the majority of them (58.1% to 94.8%) not receiving statins. The application of a 1.5 multiplier identified 17% to 78% more at risk patients.

Conclusions Depending on the risk stratification method, 2% to 26% of patients with RA without CVD have sufficiently high risk to require statin therapy, yet most of them remain untreated. To address this issue, we would recommend annual systematic screening using the nationally applicable risk calculator, combined with regular audit of whether treatment targets have been achieved.

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Footnotes

  • Funding This work is supported by an Arthritis Research Campaign Clinical Fellowship grant (grant number 18848 to TET) and an Arthritis Research Campaign infrastructure support grant (grant number 17682, given to the Dudley Group of Hospitals NHS Foundation Trust, Department of Rheumatology). VFP is supported by a PhD scholarship from the Empirikion Institute, Athens, Greece.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Black Country ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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