Background Cardiovascular risk (CVR) is increased in RA and should be evaluated annually. EULAR recommends using the SCORE equation to calculate risk, after applying a multiplier of 1.5 in patients with RA who meet two of the following three criteria: disease duration >10 years, rheumatoid factor or anti-CCP antibody positivity, presence of extra-articular manifestations. European guidelines recommend statin therapy for subjects with high or very high risk i.e patients aged 45-65 years when CVR calculated with the SCORE equation is ≥10% and LDL-cholesterol is ≥1.8 mmol/l, or when CVR is >5% and <10% and LDL-cholesterol is ≥2.5 mmol/l. American recommendations have recently changed and a new equation to assess overall CVR has been validated. Statin therapy is recommended for subjects aged 40-75 years when CVR is ≥7.5%. According to both European and American recommendations, all patients with prior cardiovascular events (myocardial infarction (MI), stroke, lower limb arteriopathy) and all diabetic patients should receive statins.
Objectives Assess the need for statin treatment in an established RA cohort (COMEDRA study) according to European and American recommendations with and without application of the multiplier proposed by EULAR, in patients aged 45-65 years, in order to compare the two sets of recommendations; and assess statin prescription in RA as secondary prevention or in diabetic patients.
Methods The COMEDRA study evaluated the impact of a nurse consultation on the management of comorbidities of RA. All patients in this study had a lipid workup and all CVR factors were noted.
Results 620 patients (79.8% women) with established RA (mean disease duration 13.2±9.9 years) were analyzed. RA was erosive in 447 (73%) and 524 (84.6%) had positive RF or anti-CCP antibodies. 450 patients (72.9%) were treated with a biologic and 223 (36%) received glucocorticoids (mean, 5.5±5.6 mg/day). One hundred (16.1%) patients had a family history of early onset CV disease, 155 (15%) were treated for hypertension, 110 (17.7%) were on lipid lowering drugs, 136 (21.9%) had BP >140/90, 124 (20%) were smokers. 7 (1%) patients had prior MI, 15 (2.4%) had prior stroke and 6 (1%) had lower limb arteriopathy. 33 (5.3%) patients were diabetic. According to European recommendations, 13 should receive statins, of whom 6 (46%) were treated and by applying EULAR recommendations 17 should receive statins, of whom 10 (59%) were treated. According to American recommendations, 150 should receive statins, of whom 32 (46%) were treated and by applying the same multiplier of 1.5, 234 should receive statin, of whom 45 (59%) were treated. Only 8/28 (28.5%) patients in secondary prevention and 11/33 (33.3%) of diabetic patients received a statin.
Conclusions According to the recommendation used, the number of RA patients requiring statin varies by a factor 10. More information is needed on which recommendation set performs best for prediction of long-term outcomes.
Disclosure of Interest None declared