Background Cardiovascular (CVD) risk factor management may be suboptimal in people with inflammatory arthritis (IA) (rheumatoid arthritis [RA], psoriatic arthritis [PsA], ankylosing spondylitis [AS]).
Objectives We compared hyperlipidemia treatment of participants with and without IA, controlling for individual-level factors that influence health services utilization.
Methods The REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort includes 30,239 community dwelling black and white adults from the 48 contiguous US states recruited between 2003–7 and assessed with a telephone survey and in-home visit that included a blood draw and pill bottle review.1 IA was identified through medications specific to autoimmune disease. Individuals with IA (without diabetes or hypertension) were compared to those with diabetes (but no IA), hypertension (but no diabetes or IA), or IA, diabetes, or hypertension. Logistic regression models examined odds of treatment among those with hyperlipidemia after accounting for predisposing, enabling, and need factors guided by Andersen and Aday's model.2
Results IA participants were younger and predominately women, with lower Framingham risk scores, and lower functional status (Table 1). Proportionately fewer IA patients were treated than others (Figure 1). The fully adjusted odds of treatment for those with IA were 27% lower but not significantly different from those without IA, hypertension, or diabetes. Participants with diabetes and HTN were 2-times more likely to be managed for hyperlipidemia than those without IA, diabetes, or hypertension.
Conclusions In this study, hyperlipidemic participants with IA were less likely to be treated for hyperlipidemia than participants with diabetes or hypertension - diseases well known to increase CVD risk – even after accounting for levels of CVD risk. This study was limited by power. If confirmed in larger samples, these results reflect a potential gap in the management of hyperlipidemia for IA patients.
Howard VJ, Cushman M, Pulley L, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology. 2005;25(3):135–143.
Aday LA, Andersen R. A framework for the study of access to medical care. Health services research. Fall 1974;9(3):208–220.
Acknowledgement A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org.
Disclosure of Interest None declared