Background Rheumatoid arthritis (RA) is recognized as an independent cardiovascular risk factor. Guidelines for cardiovascular risk (CVR) management, advise aggressive treatment in RA. Tight treatment for CVR factors in RA is not standard care and there are no prospective data.
Objectives To investigate the efficacy of CVR intervention in RA patients participating in the FRANCIS study. FRANCIS is a prospective, randomized, single centre study in RA, initiated before the guidelines advocating CVR treatment in RA patients became available.
Methods RA patients ≤70 years old with a CVR score <20% and without the presence of clinical cardiovascular disease or diabetes mellitus were included. Patients were randomized to a treat-to-target (TTT) or standard care. TTT consisted of dietary and lifestyle advice and a targeted intervention for blood pressure, lipids and glucose. Patients in the standard care group were referred to their general practitioner with a letter containing treatment advice. Patients underwent a standard physical examination, measurement of carotid intima media thickness (cIMT) and determination of the rheumatoid arthritis activity score (DAS28). Standard laboratory measurements including a complete lipid profile were measured. Both groups visited the outpatient clinic every six months.
Results In total 318 patients were included of whom 219 patients (69%) had a completed baseline and 1-year follow up data set. 106 patients received standard care and 113 treat-to-target. At baseline there was no difference between usual care and tight control in systolic BP, LDL-C, HDL-C, apoB, triglycerides, glucose cIMT and DAS28. After 1-year of follow up, the LDL-C, apoB levels and systolic BP were lower in both groups. The decrease in LDL-C after one year was significantly greater in the treat-to-target group compared to standard care (-0.7±0.8mmol/L vs.-0.2±1.0mmol/L; P<0.001). The change in systolic BP was not significantly different (-4.7±15,2 mmHg vs. -4.1±18.3mmHg; P=0.79). cIMT increased significantly in the standard care group (+0.019±0.013mm; P=0.01), but not in the treat-to-target group (+0.010±0.059mm; P=0.09).
Conclusions This is the first prospective study in RA showing that a structured cardiovascular intervention program leads to lower LDL-C levels, and delayed progression of cIMT after 12 months.
Disclosure of Interest None declared
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