Background Patients with rheumatoid arthritis (RA) have a significantly increased risk for cardiovascular (CV) morbidity and mortality when compared to general population (1). Preventive cardio-rheuma clinics have been created in recent years and proven to be effective to manage CV risk in patients with inflammatory joint diseases around the world (2).
Objectives To evaluate the need for lipid-lowering intervention in Mexican mestizo patients with RA.
Methods We initiated a preventive cardio-rheuma clinic for appropriate CV disease prevention in patients with RA in our population. A complete evaluation and CV risk stratification was performed to our patients, including blood tests and ultrasound examination of both carotid arteries. Each patient was classified to lifestyle changes only, a lifestyle intervention plus lipid-lowering treatment, or to have a low risk with no need for intervention, in accordance to the 2012 European Guidelines on cardiovascular disease prevention in clinical practice and the 2016 ESC/EAS Guidelines for the Management of Dyslipidemias.
Results A total of 100 patients were evaluated, patient characteristics and intervention group distribution are shown in Table 1. Among these patients, 49 were found not to need any lipid-lowering intervention. The remaining 51 were classified into lifestyle change (n=18, 35.3%) or lipid-lowering drug regimens (n=33, 64.7%). A significant difference between intervention groups was only found regarding age (p<0.001). A multiple regression analysis was performed to predict the kind of intervention needed from age, disease duration, disease activity and autoantibody levels, only age added statistically significantly to the prediction (p<0.001).
Conclusions There was indication for preventive intervention in more than half of our patients. Age is a determinant factor that increases CV risk in RA patients independently from disease-specific factors. Treatment to lipid targets is essential to reduce their risk of CV morbidity and mortality (3). A prospective study evaluating treatment success rate is needed to further evaluate the intervention of the clinic.
Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, et al. Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis. Clin Rheumatol. 2016;35(11):2823–7.
Rollefstad S, Kvien TK, Holme I, et al. Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic. Ann Rheum Dis. 2013;72(12):1968–74.
Rollefstad S, Ikdahl E, Hisdal J, Olsen IC, et al. Rosuvastatin-Induced Carotid Plaque Regression in Patients With Inflammatory Joint Diseases: The Rosuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and Other Inflammatory Joint Diseases Study. Arthritis Rheumatol. 2015;67(7):1718–28.
Disclosure of Interest None declared