Background EULAR recommendations for cardiovascular disease (CVD) risk management in inflammatory joint diseases (IJD) advocate annual CVD risk assessment. Knowledge of the most prevalent CVD risk factors in the different IJD diagnoses may enable tailoring of efficient CVD preventive strategies for these high risk patients.
Objectives 1) Evaluate prevalence of CVD risk factors in IJD patients and estimate 10-year risk for fatal CVD using the Systemic COronary Risk Evaluation (SCORE). 2) Investigate possible differences in CVD risk factor distribution across IJD entities.
Methods In the nationwide NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) project, annual CVD risk assessment is implemented in clinical practice of 11 rheumatology centres. IJD patients ≥30 years of age are eligible for inclusion. CVD risk factors and established CVD are recorded. The estimated CVD risk by SCORE was compared across IJD diagnoses for males and females individually, using analysis of variance, stratified by decennial age. Number of CVD risk factors, determined by presence of diabetes, hypertension, family history of premature CVD, hyperlipidemia (total cholesterol >8 mmol/L and/or low-density lipoprotein cholesterol >6 mmol/L), current smoking or obesity (body mass index ≥30kg/m2), was counted for each patient. Frequency of CVD risk factors for the whole cohort was estimated and compared across the four major entities, using age and sex adjusted logistic regression analyses.
Results Of the 2647 patients included in the 3 initial centres (Rheumatoid arthritis [RA]: n=1696, ankylosing spondylitis [AS]: n=445, psoriatic arthritis [PsA]: n=376, other spondyloarthritides [SpA]: n=130), 58.0% were females and the median (inter-quartile range [IQR]) age and disease duration were 57.4 (46.8–66.8) and 8.0 (3.8–15.9) years, respectively. The median (IQR) SCORE estimate was 1.4% (0.4–2.9) for the total population. The calculated CVD risk by SCORE was comparable across diagnoses, apart from male AS patients with a lower estimated CVD risk (p=0.01). Prevalence of CVD risk factors were comparable across all the IJD diagnoses, except for PsA patients who had significantly more CVD risk factors in the two oldest age groups (p=0.01). The percentage of patients with at least one CVD risk factor and the mean number of risk factors for each patient are presented in the Figure. In detail, CVD risk factor rates were: family history of premature CVD: 17.5%, established CVD: 9.8%, current smoking: 19.6%, hypertension: 53.2%, obesity: 17.9%, diabetes: 6.7% and hyperlipidemia: 1.3%. PsA patients were more obese (p=0.001), more often hyperlipidemics (p<0.05), had more diabetes (p<0.001) and hypertension (p<0.0001), and were less frequently smokers (p=0.04). RA patients were more often smokers (p=0.02) and hypertensive (p=0.01).
Conclusions In a large, multicentre cohort of IJD patients, a high prevalence of CVD risk factors was revealed, also in young patients. Interestingly, the risk factor burden was comparable in the 3 age categories across all IJD. Hence, CVD risk factor recording is essential in all IJD, and especially for PsA patients who had the largest CVD risk factor burden compared to the other IJD diagnoses.
Disclosure of Interest None declared