Towards improving cardiovascular risk management in patients with rheumatoid arthritis: the need for accurate risk assessment
- 1Department of Health Sciences Research, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- 2Division of Rheumatology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Correspondence to Professor Sherine E Gabriel, 200 First Street SW, Rochester, Minnesota 55905, USA;
- Accepted 23 January 2011
- Published Online First 22 February 2011
Numerous reports of the increased incidence of cardiovascular disease (CVD) among patients with rheumatoid arthritis (RA) have been published during the past decade.1 2 In addition, the increased risk of CVD in patients with RA cannot be explained by traditional CV risk factors alone.3 4 While these reports have increased awareness of CV morbidity and mortality among patients with RA, the lack of CV risk assessment tools and evidence-based practice guidelines developed specifically for patients with RA has slowed the translation of this knowledge into clinical decision making. The following two case studies illustrate the need for accurate RA-specific CV risk assessment tools.
The first patient, a woman, was diagnosed as having RA at age 40 with rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) positivity and rheumatoid nodules present at diagnosis. She was a non-smoker and non-diabetic with total cholesterol of 6.7 mmol/litre (258 mg/dl), high-density lipoprotein cholesterol (HDL-c) of 1.4 mmol/litre (54 mg/dl) and a systolic blood pressure of 120 mm Hg. The SCORE (for 'Systematic COronary Risk Evaluation') risk assessment for populations at high CVD risk categorised her 10-year risk of fatal CVD as <1% and the general Framingham Risk Score (FRS) estimated her 10-year risk for any CVD event as 4%.5 6 Despite these low risk assessments, she experienced a myocardial infarction (MI) at age 45. Thus, the SCORE and FRS did not accurately predict CV risk for this patient.
The second patient, a man, was diagnosed as having RA at age 46 with RF/ACPA positivity and rheumatoid vasculitis present at diagnosis. He was a non-smoker and non-diabetic with total cholesterol of 8.8 mmol/litre (341 mg/dl), HDL-c of 2.0 mmol/litre (76 mg/dl), a systolic blood pressure of 140 mm Hg and normal body mass index (26 kg/m2). His SCORE risk was 2.6% …