Background Persons with rheumatoid arthritis (RA) have an increased risk for development of cardio-vascular-disease (CVD) and screening is recommended (1).
Objectives To investigate the spread of risk factors for development of CVD and estimate the risk for cardio-vascular death in a hospital population with RA according to the EULAR recommendations (1).
Methods Outpatients with RA ≤ 85 years of age connected to King Christian X’s Hospital for Rheumatic diseases in Graasten, Denmark, were invited for a 30 minute nursing consultation. Risk for cardiovascular death was calculated according to the SCORE system (2) based on total/HDL-cholesterol ratio, smoking habits, blood pressure, age and gender (Denmark high risk country). The SCORE was adjusted depending on the patients’ disease duration, IgM-RF and/or anti-CCP positivity and the presence of certain extra articular manifestations (1). History of CVD and diabetes mellitus (DM), fasting glucose, Body Mass Index (BMI), waist circumference and exercise habits were explored.
Results From September 2011-November 2012 a total of 836 patients completed the screening; 598 (71.5%) female; Mean age 64.3(12.0). In total 152(19.1%) were already diagnosed with CVD and 74(9%) with DM; 95(14.3%)of the patients without DM had a fasting glucose ≥6.0mM/l. Among the 644 patients with no known CVD or DM, 158(24.5%) were smokers; 229(35.8%) had a systolic blood pressure ≥140; 397(65.6%) had a total-cholesterol ≥5.0mM/l; 326(55.4%) a LDL-cholesterol≥3.0 mM/l; 18(4.0%) female and 19(12.1%) male patients had a HDL-cholesterol level below the recommended 1.2/1.0 mM/l respectively. BMI was >25 in 409(63.8%); waist circumference (cm) were above 80 (female)/ 94 (male) in respectively 297(63.3%) and 111(63.8%) patients; 418(64.9%) exercised less than five times a week. The risk SCORE was ≥5 in 122 (20.2%) of the patients with no known DM or CVD and they were referred to follow-up by their General Practitioner and community advice services. This number will decrease to 99 (16.2%) as Denmark is considered to be a low-risk country from May 2012.
Conclusions Systematic screening revealed several risks factors which needed medical follow-up or support to initiate life-style changes. More than 20% had an increased risk of 5% or more for cardiovascular death in 10 years.
Peters, M.J., et al., EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis, 2010. 69(2): p. 325-31. 2: Conroy, R.M., et al., Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J, 2003. 24(11): p. 987-1003.
Disclosure of Interest None Declared