EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome
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  • Published on:
    What should be the threshold to initiate pharmacological treatment of hyperlipidaemia?
    • ANAND MALAVIYA, Consultant Rheumatologist ISIC Superspeciality Hospital, Vasant Kunj, New Delhi, India - 110070

    The Editor, A R D
    This has reference to the EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome [1]. These recommendations will help most of the practicing rheumatologists in getting actively involved the prevention of atherosclerotic cardiovascular disease in RMDs. However, I seek one clarification the answer of which, I did not find in this document. What exact measure/instrument should I be using to guide me for pharmacological intervention for appropriate lipid-control? Should I be only using any one of the ‘CVD 10-y risk prediction instruments’ (modified Framingham Risk score, ‘SCORE’, ‘QRISK3’) and using a cut-off of 10-year-risk of > 5% as a guide to initiate pharmacological intervention for lipid-control (besides life-style change recommendations)? Or should I use the widely endorsed recommendations/guidelines from different cardiology/cholesterol societies around the world? For example, presently most such recommendations suggest the formulae ‘total cholesterol minus_HDL-cholesterol’ or ‘total cholesterol/HDL-cholesterol ratio’ providing cutoff values (>120 or 130mg/dL/>3.5 to 5, respectively) above which pharmacological intervention for lipid-control must be initiated. Opinion of the experts will be highly appreciated.
    Yours Truly
    Anand N. Malaviya, Department of Rheumatology.
    ISIC Superspeciali...

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    Conflict of Interest:
    None declared.
  • Published on:
    Standard cardiovascular risk scales for people with gout?
    • Mariano Andres, Rheumatologist and Adjunct Professor Alicante General University Hospital-ISABIAL, Miguel Hernandez University, Alicante, Spain.

    Dear editor,
    I read with interest the recently published new EULAR recommendations for managing the cardiovascular risk in patients with inflammatory rheumatic diseases [1]. They were long-awaited, and opportunely the targeted diseases are now broader, as previous ones focused primarily on chronic inflammatory arthritis [2].

    With rising numbers worldwide, gout is a major cardiovascular risk factor directly linked to all forms of atherosclerotic diseases. By having gout, there is a 40% increased chance of dying from the coronary disease [3]. So, focused management to reduce these serious complications is necessary, and establishing an individual patient's risk is essential. Surprisingly, the experts rely on risk prediction using standard risk assessment tools, claiming the absence of validation studies. I should partially disagree at this point. Certainly, no longitudinal studies have evaluated the predicted rates of cardiovascular events in gout to date. However, our group studied the discriminative value of SCORE and Framingham tools in detecting patients with carotid plaques, a high-risk indicator [4]. A moderate discriminative capacity was unveiled, with areas under the curve of 0.711 for SCORE and 0.683 for Framingham [5]. Specificity was quite good, but the tools lacked enough sensitivity. Moreover, Gamala and colleagues incorporated gout into the modified Dutch SCORE as an inflammatory risk factor [6]. It led to a 28.3% upgrade to the high-risk stag...

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    Conflict of Interest:
    None declared.