Background Rheumatoid arthritis (RA) is recognized as an independent cardiovascular (CV) risk factor. The ongoing inflammatory state in RA is believed to be the main cause of this increased CV risk. However, underdiagnosis and undertreatment of traditional CV risk factors in patients with RA is suggested, which potentially contributes to the overall CV risk in RA patients. National and international guidelines advise aggressive treatment of traditional CV risk factors in RA [1, 2].
Methods RA patients up to 70 years of age without CV disease (AMI, PTCA, CABG, CVA, TIA, severe claudicatio, PTA and/or amputation due to arterial vascular disease) and/or diabetes mellitus were included. Patients underwent a standard physical examination, including systolic blood pressure (sBP) and DAS28. Standard laboratory measurements including a fasting lipid profile were measured.
Results Results: 5 (2%) of 315 referred patients were diagnosed with de novo type 2 diabetes mellitus. 310 Patients were included with a mean (±SD) age of 53.3±11.3 years and a mean disease duration of 9.58±8.99 years. The mean DAS28 was 2.43±1.06. 68% of the patients were female (n=212). 55 (17%) patients were already treated for hypertension. 37 (67%) of these patients were inadequately treated (sBP ≥140mmHg). A sBP >140mmHg was observed in 80 (32%) RA patients without prior hypertension. The mean LDL-C levels were 3.4±0.9 mM for those without lipid lowering therapy and 3.0±1.1 mM for the patients who received statin therapy (n=14). A total of 80% of RA patients showed a LDL-C ≥2.5 mM, which has been recommended as treatment target.
Conclusions Almost two thirds of the RA patients with hypertension did not reach treatment targets and a sBP >140mmHg was observed in one third of the RA patients without a prior diagnosis of hypertension. The new advised treatment target for hypercholesterolemia in RA was only met by 20% of the patients. Our study suggests that there is a marked underdiagnosis and undertreatment of hypertension and hypercholesterolemia in RA patients. There is need for improved CV risk assessment in RA patients.
Peters MJ, Symmons DP, McCarey D et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Annals of the rheumatic diseases. 2010 Feb;69(2):325-31.
Wiersma T, Smulders YM, Stehouwer CD, et al. [Summary of the multidisciplinary guideline on cardiovascular risk management (revision 2011)]. Nederlands tijdschrift voor geneeskunde. 2012;156(36):A5104.
Catapano AL, Reiner Z, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. 2011 Jul;217(1):3-46.
Disclosure of Interest None Declared