Background It is becoming increasingly accepted that cardiovascular events are an important comorbidity in rheumatoid arthritis. Myocardial infarction, heart failure and cardiac death are significantly increased in rheumatoid patients compared to controls and the similarity of the risk elevation to that of Type 2 Diabetes is a striking fact1. EULAR recommendations include yearly assessment of cardiovascular risk factors2. It is therefore important to observe both patient awareness regarding the increased risk of cardiovascular events and the patterns of risk factor monitoring in everyday rheumatological practice.
Objectives The aim of this audit was to study patients’ awareness regarding their increased cardiovascular risk and to record frequency of monitoring and presence of cardiovascular risk factors.
Methods 124 consecutive rheumatology out-patients answered questions regarding basic epidemiological data, the presence of various cardiovascular risk factors such as diabetes, smoking and family history and a record was made of the blood pressure on the day as well as recent results of glucose and lipid measurements. The central question was whether they were aware of an increased cardiovascular risk.
This group of patients attend a private hospital where most of the education, monitoring and support is carried out by the rheumatologist alone. One relies on the patient more than in other healthcare systems, for regular blood tests.
Results The female to male ratio was 3.4 to 1. The commonest medication was methotrexate (67%) and 13% were on biologic agents. 15% had type 2 diabetes, 17% were current and 6% past smokers. 24% had a first degree relative with ischaemic heart disease. Blood pressure measurement: 40% of patients had a blood pressure measurement in the past month and 48% between 1-6 months previously. 6% had a measurement between 6-12 months and 6% more than a year previously. 31% had blood pressure above 140/90on the day. Glucose and lipids: 32% of patients did not have lipid or glucose measurements in the previous 6 months. Of those with recent results, 37% had total cholesterol outside the normal range. Mean fasting glucose level was 93.7mg/L and 24% had fasting glucose above the normal range. Body Mass Index (BMI): Mean BMI was 26.1 for the group. Specifically, 19% were overweight and 5% underweight.
In answer to the central question 72% did not know that rheumatoid arthritis increases the risk of cardiovascular disease and only a third of the ‘well informed’ had an idea of what measures could be taken to reduce the risk.
Conclusions This was a small audit, but some of the results can help improve patient care. A significant proportion did not have recent glucose and lipid measurement but blood pressure had been measured very recently in the vast majority of patients.
A high proportion of RA patients were unaware of their increased risk of cardiovascular disease. One should improve communication of this risk and reassess patient awareness.
Van Halm VP, Peters, MJL, Voskuy AE et al. Ann Rheum Dis 2009;68:1395-1400 doi:10.1136/ard.2008.094151
Peters MJL, Symmons DPM, McArey D et al. Ann Rheum Dis 2010;69:325-331 doi:10.1136/ard.2009.113696
Disclosure of Interest None Declared