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SP0165 How to Evaluate Cardiovascular Risk in Patients with Inflammatory Joint Disease – A Review of the Evidence
  1. A.G.P. Semb
  1. Preventive Cardio-Rheuma clinic, Diakonhjemmet Hospital, Oslo, Norway

Abstract

The increased risk of cardiovascular (CV) morbidity and mortality in patients with rheumatoid arthritis (RA) has been known for decades [1]. CV disease is a major factor in the widening mortality gap between patients with RA and the general population [2]. There is no longer doubt that the increased CV risk in RA equals that of patients with diabetes mellitus [3].

While there is a large body of knowledge regarding the increased CV risk in RA, there is a lack of clinical evidence regarding management of this increased risk [4]. Important and unaddressed questions include: Are the CV preventive recommendations for the general population also adequate for the patients with RA? Should the traditional risk factors be tailored specifically to RA patients, with modified treatment thresholds and targets? Are there subgroups of RA patients with excess or with lower CV risk who should be identified?

As physicians we are conscious to act on evidence in order to make decisions about interventions to improve health. The evidence vacuum in the field of CV prevention and clinical outcome in patients with RA has been well discussed in a recently published debate article [5]. Interestingly, there is a broad agreement that RA patients fulfilling general population criteria for recommended CV risk reduction should receive proven interventions including smoking cessation, weight reduction, blood pressure control and lipid lowering therapy. In accordance with these recommendations, and despite all the uncertainties regarding CV treatment thresholds, targets and outcome results in RA, we firmly advocate CV risk to be assessed and acted upon in patients with RA, as recommended for the general population until a validated RA specific calculator is available.

Several studies have shown that in daily clinical practice the CV risk in patients with RA is underestimated [6–10]. In part, this relates to underuse of tools for systematic evaluation of CV risk and prevention in these patients. Care of CV risk in patient with RA is an interdisciplinary task between cardiology, rheumatology and primary care, and there is confusion regarding which healthcare providers have the responsibility of recording and evaluating CV risk factors and further initiating appropriate medical interventions and modification of lifestyle related risk factors.

We urge that CV risk should be assessed and recorded in all patients with RA in routine clinical practice. It is undoubtedly better to take action than ignoring high CV risk even as educational CV preventive programmes are developed and hard CV end point studies are undertaken.

The implementation of theory into clinical practice is a huge task and must necessarily address areas of uncertainty. This session will focus on the practicalities of CV risk factor evaluation including recording, assessment, evaluation and awareness in RA patients.

References

  1. Avina-Zubieta JA et al. Arthritis Rheum 2008; 59(12):1690-1697.

  2. Gonzalez A et al. Arthritis Rheum 2007; 56(11):3583-3587.

  3. Lindhardsen J et al.Ann Rheum Dis 2011; 70(6):929-934.

  4. Semb AG et al. Ann Rheum Dis 2014 Doi: 10.1136/annrheumdis-2013-204792

  5. Solomon DH et al. Arthritis Rheum 2013; 65(7):1675-1683.

  6. Bell C et al. Musculoskeletal Care 2011; 9(2):69-74.

  7. Bartels CM eeet al. Semin Arthritis Rheum 2012; 42(1):9-16.

  8. Eirik Ikdahl et al. Arthritis Rheum 2013;65(suppl 19):209.

  9. Crowson CS et al. Ann Rheum Dis 2011; 70(5):719-721.

  10. Teir J et al. Rheumatology (Oxford) 2008; 47(8):1252-1254.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.6268

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