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Statin use in rheumatoid arthritis in relation to actual cardiovascular risk: evidence for substantial under treatment of lipid associated cardiovascular risk?
  1. Tracey E Toms1,*,
  2. Vasileios F Panoulas1,
  3. Karen M J Douglas1,
  4. Helen Griffiths2,
  5. Naveed Sattar3,
  6. Jacqueline P Smith1,
  7. Deborah P.M Symmons4,
  8. Peter Nightingale5,
  9. George S Metsios1,
  10. George D Kitas1
  1. 1 Dudley Group of Hospitals NHS Foundation Trust, United Kingdom;
  2. 2 Life and Health Sciences, Aston University, Birmingham, United Kingdom;
  3. 3 Univesity of Glasgow, Glasgow, Scotland, United Kingdom;
  4. 4 arc Epidemiology Unit, Manchester University, Manchester, United Kingdom;
  5. 5 Wolfson Computer Laboratory, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  1. Correspondence to: Tracey e Toms, rheumatology, Dudley group of hospitals NHS trust, 55, stoneton crescent, Balsall common, Solihull, Cv7 7QR, United Kingdom; tomstracey{at}


Background: Cardiovascular disease (CVD) is partially attributed to traditional cardiovascular risk factors, which can be identified and managed based on risk stratification algorithms (Framingham Risk Score, National Cholesterol Education Program, Systematic Cardiovascular Risk Evaluation and Reynolds risk score). We aimed to: (a) identify the proportion of at risk RA patients requiring statin therapy identified by conventional risk calculators, and (b) assess whether patients at risk were receiving statins.

Methods: Patients at high CVD risk (excluding patients with established CVD or diabetes) were identified from a cohort of 400 well-characterised RA patients, by applying risk calculators with or without a x1.5 multiplier in specific patient subgroups. Actual statin use versus numbers eligible for statins was also calculated.

Results: The percentage of patients identified as being at risk ranged significantly depending on the method, from 1.6% (for 20% threshold global CVD risk) to 15.5% (for CVD and cerebrovascular morbidity and mortality) to 21.8% (for 10% global CVD risk) and 25.9% (for 5% CVD mortality), with the majority of them (58.1%-94.8%) not receiving statins. The application of a 1.5 multiplier identified 17%-78% more at risk patients.

Conclusions: Depending on the risk stratification method, 2%-26% of RA patients without CVD have sufficiently high risk to require statin therapy, yet most of them remain untreated. To address this issue, we would recommend annual systematic screening using the nationally applicable risk calculator, combined with regular audit of whether treatment targets have been achieved.

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