Application of the European Society of Cardiology, Adult Treatment Panel III and American College of Cardiology/American Heart Association guidelines for cardiovascular risk management in a French cohort of rheumatoid arthritis

Tournadre, Anne; Tatar, Zuzana; Pereira, Bruno; Chevreau, Maxime; Gossec, Laure; Gaudin, Philippe; Soubrier, Martin; Dougados, Maxime

doi:10.1016/j.ijcard.2015.01.069

Cited by 18 publications

(12 citation statements)

References 28 publications

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“…Tournadre et al calculated the proportion of patients eligible for statins according to ESC guidelines, the Adult Treatment Panel III, and the ACC/AHA in a French cohort of statin-naïve rheumatoid arthritis patients at least 40 years of age. A marked discordance in risk assessment and cholesterol treatment was observed between the three sets of guidelines 21 . The difference with the present work could be explained by the populations studied, plus the fact that a multiplication factor was used in this study.…”

Section: Discussioncontrasting

confidence: 80%

Should all patients with psoriasis receive statins? Analysis according to different strategies

Masson

Lobo²,

Molinero³

et al. 2019

Anais Brasileiros de Dermatologia

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BackgroundDifferent strategies have been proposed for the cardiovascular risk management of patients with psoriasis.ObjectiveTo estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy.MethodsA retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed.ResultsA total of 892 patients (mean age 59.9 ± 16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1–27.0%) and 1.9% (IQR 0.4–5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively.Study limitationsThis was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis.ConclusionThis population with psoriasis was mostly classified at moderate–high risk and the statin therapy indication was similar when applying the two strategies evaluated.

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Section: Discussioncontrasting

confidence: 80%

Should all patients with psoriasis receive statins? Analysis according to different strategies

Masson

Lobo²,

Molinero³

et al. 2019

Anais Brasileiros de Dermatologia

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“…Overall, our findings suggest that the use of the 2013 ACC/AHA risk score would result in changes in management recommendations for initiation of lipid-lowering therapy and for more aggressive lifestyle modification in a significant number of rheumatologic patients. Consistent with that notion, a previous French multicenter study of 677 statin-naïve RA patients demonstrated that statins would be recommended in 78.5% of men and 38.8% of women according to the 2013 ACC/AHA guidelines compared to only 53.1% of men and 15.6% of women according to the ATP-III guidelines [17]. The results of our study are difficult to directly compare to that study given that our study addressed discordance in risk categorization rather than discordance in recommendations for statin therapy in statin-naïve patients, but the higher rate of discordance in that study may be explained by application of the EULAR 1.5 multiplier to both risk scores in nearly 60% of subjects (depending on specific RA characteristics).…”

Section: Discussionmentioning

confidence: 67%

Discordance of the Framingham cardiovascular risk score and the 2013 American College of Cardiology/American Heart Association risk score in systemic lupus erythematosus and rheumatoid arthritis

et al. 2017

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Despite the increasing use of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular (CV) risk score in clinical practice, few studies have compared this score to the Framingham risk score among rheumatologic patients. We calculated Framingham and 2013 ACC/AHA risk scores in subjects with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and assessed demographic, CV, and rheumatologic characteristics associated with discordant scores (high-risk ACC/AHA scores but low-risk Framingham scores). SLE and RA subjects drawn from two population-based cohort studies were assessed during in-person study visits. We used chi-squared tests and t tests to examine the association of discordant CV risk scores with baseline characteristics. Eleven (7.0%) of 157 SLE subjects and 11 (11.5%) of 96 RA subjects had discordant CV risk scores with high ACC/AHA scores and low Framingham scores. These findings did not significantly change when a 1.5 multiplier was applied to the Framingham score. Rheumatologic disease duration, high-sensitivity CRP levels, African-American race, diabetes, current use of anti-hypertensive medication, higher age, and higher systolic blood pressure were each significantly associated with discordant risk scores. Approximately 10% of SLE and RA subjects had discordant 10-year CV risk scores. Our findings suggest that the use of the 2013 ACC/AHA risk score could result in changes to lipid-lowering therapy recommendations in a significant number of rheumatologic patients. Prospective studies are needed to compare which score better predicts CV events in rheumatologic patients, especially those with risk factors associated with discordant risk scores.

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“…125 Compared with previous guidelines, in patients with RA, this calculation considerably increased the number who would be recom mended for cholesterollowering statin treatment, but did not improve prediction of cardiovascular risk. 126,127 Patients with RA often suffer from asymptomatic atherosclerosis and silent ischaemic disease in the presence of an unstable plaque, which can lead to sudden death. 128 An early diagnosis of atherosclerosis, before the onset of clinically evident cardiovascular disease, can enable earlier and more aggressive primary prevention measures.…”

Section: Risk-prediction Modelsmentioning

confidence: 99%

Cardiovascular comorbidity in rheumatic diseases

2015

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Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity.

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Application of the European Society of Cardiology, Adult Treatment Panel III and American College of Cardiology/American Heart Association guidelines for cardiovascular risk management in a French cohort of rheumatoid arthritis

Cited by 18 publications

References 28 publications

Should all patients with psoriasis receive statins? Analysis according to different strategies

Should all patients with psoriasis receive statins? Analysis according to different strategies

Discordance of the Framingham cardiovascular risk score and the 2013 American College of Cardiology/American Heart Association risk score in systemic lupus erythematosus and rheumatoid arthritis

Cardiovascular comorbidity in rheumatic diseases

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