Background Existing guidelines advocate aggressive management of dyslipidemia in rheumatoid arthritis (RA) patients according to cardiovascular disease (CVD) risk scores generated for the general population (SCORE). More specific RA scores such as the ERS-RA score have not been extensively studied.
Objectives To evaluate the use of lipid-lowering agents for CVD prevention (primary/secondary) in RA patients according to different CVD risk scores (SCORE, ERS-RA).
Methods Prospective, multicenter (12 hospitals, 6 private offices), cross-sectional, epidemiological study in Greece (06/2015–01/2016, RA Study Group). Demographics, disease characteristics, treatment and comorbidities were collected and SCORE/ERS-RA were calculated.
Results Among 1475 patients, 178 (12%) had CVD (44% coronary artery disease, 44% peripheral vascular disease, 27% stroke) and 43% were not receiving any hypolipidemic therapy. From those on therapy, only 12% achieved an LDL-cholesterol (LDL-C) level <70 mg/dl while 48% had LDL-C<100 mg/dl. 859 patients without CVD, diabetes or hypolipidemic therapy were further analyzed (79% women, mean age 59.5 yrs, mean disease duration 3.4 yrs, mean DAS28-ESR 3.4, mean HAQ 0.45). Complete data for SCORE calculation were available in 225/859 patients (26%). When stratified according to CVD risk, 31.5%, 66%, 2% and 0.5% of patients had a SCORE of <1% (low risk), ≥1 to <5% (moderate), ≥5 to <10% (high) and ≥10% (very high), respectively. In moderate risk (1–5%) patients, 78% had an LDL-C>100 mg/dl while among high or very high risk (≥5%) patients, 100% had an LDL-C>70 mg/dl (target groups for drug therapy). Among 996 patients (40–75 yrs old), without CVD events, there were 99 diabetic patients (10%) and less than half (48%) were on hypolipidemic therapy. For the rest, the ERS-RA score was calculated (619/897, 69% with available data); 50% of them (308/619) had a 10-year risk of ≥7.5% (therapeutic cutoff) but only 40% of patients in this group were being treated.
Conclusions A substantial proportion of RA patients with established CVD or diabetes do not receive lipid-lowering therapy or they do not achieve therapeutic targets. Among those without CVD or diabetes, more than half belong to moderate to high CVD risk groups and are not receiving appropriate hypolipidemic therapy.
Acknowledgement Supported by grants from the Hellenic Rheumatology Society and Professional Association of Rheumatologists.
Disclosure of Interest None declared