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Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic
  1. Silvia Rollefstad1,
  2. Tore K Kvien1,2,
  3. Ingar Holme3,
  4. Anne S Eirheim1,
  5. Terje R Pedersen2,4,
  6. Anne Grete P Semb1
  1. 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Faculty of Medicine, University of Oslo, Oslo, Norway
  3. 3Department of biostatistics, epidemiology and health economics, Oslo University Hospital-Ullevaal, Oslo, Norway
  4. 4Centre of Preventive Medicine, Oslo University Hospital-Ullevål, Oslo, Norway
  1. Correspondence to Dr Anne Grete P Semb, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, Oslo NO-0319, Norway; a-semb{at}diakonsyk.no

Abstract

Objectives To perform cardiovascular risk stratification in patients with inflammatory joint diseases (IJD) and treat to lipid targets according to recommendations.

Methods We initiated a preventive cardio-rheuma clinic based on the unmet need of adequate cardiovascular prevention in IJD patients. A full cardiovascular risk stratification was performed at the first consultation (history of conventional risk factors and of cardiovascular disease, lipid measurement, blood pressure and ultrasound examination of both carotid arteries), and the patient was classified to either a primary or secondary cardiovascular prevention regime, or to have a low risk (no intervention). Lipid-lowering treatment was adjusted until at least two lipid targets were achieved.

Results Of the 426 patients referred, 36.6% had a systematic coronary risk evaluation less than 5% (no lipid-lowering intervention). The remaining 270 patients ((rheumatoid arthritis (RA), n=165; ankylosing spondylitis (AS), n=70; and psoriatic arthritis (PsA), n=35) were assigned to either primary (n=63) or secondary prevention (n=207). There were significant differences between the patient groups regarding age (p<0.001), sex (p<0.001) and disease duration (p<0.001). Lipid changes in IJD patients were: total cholesterol −1.86±1.20 mmol/l (p<0.001); low-density lipoprotein cholesterol −1.74±1.11 (p<0.001); high-density lipoprotein cholesterol 0.01±0.30 (p=0.61); triglycerides −0.28±0.72 (p<0.001). The proportions of patients reaching at least two lipid targets were for RA 92.1%, AS 90.0% and PsA 82.9%. No serious adverse events were observed.

Conclusions There was indication for cardiovascular prevention in a high proportion of IJD patients referred for cardiovascular risk stratification. Treatment to lipid targets was successful in approximately 90% of patients with IJD.

  • Rheumatoid Arthritis
  • Ankylosing Spondylitis
  • Psoriatic Arthritis
  • Cardiovascular Disease
  • Lipids

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