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AB0313 Cardiovascular risk, biologics and anti-cyclic citrullinated peptide positivity in rheumatoid arthritis
  1. EA Jauregui,
  2. CA Agudelo,
  3. C Aldana,
  4. YA Muñoz
  1. Rheumatology, Riesgo de fractura S.A-CAYRE, Bogotá, Colombia

Abstract

Background Co-factors and traditional cardiovascular disease (CVD) risk factors contribute to atherosclerosis in rheumatoid arthritis (RA). Several records since 1953 have reported an increase of up to 4 times the CVD risk and mortality in RA patients. Physicians who evaluate these patients forget to perform or record this assessments in medical records. Since 1948, the Framingham Heart Study became an ambitious project in health research, to identify the general causes of heart disease and stroke, they proposed a new risk estimator of general cardiovascular risk defined as CVD.This estimator was calibrated for Colombia and should be multiplied by a factor of 0.7

Objectives To describe whether the request and registration of CV risk factors is performed. Also to estimate 10-year risk of CVD in RA patients and to compare the CVD risk among patients receiving or not biological therapy and those with positive and negative anti-cyclic citrullinated peptide (anti-CCP)

Methods We conducted an observational descriptive study of patients who attended a specialized rheumatology clinic in Bogotá, Colombia from 2010 to 2015. Patients with RA were enrolled who had completed at least 5 year of follow-up. The information required to estimate CVD risk was obtained from medical records. Other variables included were biological therapy and test result of anti-CCP. For the calculation of CVD risk, the Framingham estimator was used and adjusted for the Colombian population. Additionally, patients who had 2 or more of these criteria: More than 10 years of evolution of RA, positive rheumatoid factor and/or extra-articular compromise, the risk was adjusted by multiplying by 1.5. Nonparametric statistics (Mann-Whitney U test) was used.

Results We identified 273 eligible patients with RA with mean age 61, 66% women. Only 117 (42.8%) had recorded in their charts all variables to calculate CVD risk. We found that 32% had high blood pressure, 7% type II DM, 11% Obesity and 13% smoking. For the population evaluated, 10-year CVD risk median was 12.42% and for Colombia was 8.69%, adjusting this risk according to the disease in Colombia, increased to 13.03%. When we compare the 10-year CVD risk in anti-CCP positive patients (median: 11.15) and anti-CCP negative (median: 8.22) we did not find difference (p: 0.614). However, we found differences in the 10-year CVD risk median 9.04 vs. 23.25, 10-year CVD risk adjusted to Colombia median 6.32 vs. 16.31 and 10-year CVD risk adjusted to Colombia and RA median 6.81 vs. 13.39 between patients using biological therapy versus patients without receiving respectively (p: <0.001)

Conclusions Only 42.8% of the sample had all CV risk factors requested and registered in the clinical record, so should promote improvement in the health team to increase this. The average 10-year CVD risk in all people with RA was 12.42%, and in patients who met the criteria to be multiplied by the factor 1.5 increased to 13.03%, which means that these patients should be reported this and applied risk prevention guidelines regarding obesity and cholesterol levels. Despite population receiving biologics are younger, they had lower CV risk. We need more research to confirm this results

References

  1. Goff DC Jr, et al. 2013 ACC/AHA Cardiovascular Risk Guideline.

  2. M J L Peters, D P M Symmons, D McCarey et al. Ann Rheum Dis 2010;69:325–331.

  3. Arnett D, Goodman R, Halperin J, et al. Circulation. 2014; 130: 1662–1667.

References

Disclosure of Interest None declared

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