Awareness and perceived risk of cardiovascular disease among individuals living with rheumatoid arthritis is low: results of a systematic literature review

Abstract

BackgroundIndividuals with rheumatoid arthritis (RA) are at risk of developing cardiovascular disease (CVD), but patient perceptions of CVD are not routinely assessed. We performed a systematic literature review to evaluate awareness of the association between RA and CVD, and perceived risk of CVD among individuals with RA.MethodsThree electronic databases (MEDLINE, EMBASE, and PubMed) were searched for English language articles between the years of 1990–2018. Search terms pertained to RA, CVD, knowledge, awareness, or perceptions of CVD risk. Abstracts were screened for inclusion/exclusion by two independent reviewers.ResultsA total of 33 abstracts were screened and 6 underwent full review. The overall sample size was 478 subjects and included patients with established RA who were predominantly female with a mean age range of 53 to 64 years. RA disease characteristics relevant to CVD were not uniformly reported, including the use of DMARDs, corticosteroids, or NSAIDs. A high proportion of subjects (range 73 to 97%) were unaware of an increased risk of developing CVD in relation to their RA, and this frequently occurred in those with a greater number of traditional CVD risk factors. Misperceptions about CVD were common, and the majority of subjects misestimated their actual CVD risk.ConclusionIndividuals with RA at highest risk for CVD report low awareness and perceived risk of this comorbidity. This represents a knowledge gap in need of intervention but must be tailored to patients’ needs. An understanding of the system- and individual-level barriers preventing CVD awareness is needed. Only then will approaches to improve CVD screening and management in RA be successful.Electronic supplementary materialThe online version of this article (10.1186/s13075-019-1817-y) contains supplementary material, which is available to authorized users.

Misperception of the Cardiovascular Risk in Patients with Rheumatoid Arthritis

“…The results from the present study indicate that patients with RA do not perceive the increased risk of CV disease associated with this condition. In keeping with our findings, it was suggested that patients with RA do not seem to be aware of this problem [ 14 ] and often have trouble perceiving their actual CV risk [ 15 , 16 ]. With respect to this, a recent systematic review [ 16 ] identified only six studies that assessed the degree of the perceived risk of CV disease development in patients with RA, comparing it with EULAR SCORE or with classic CV risk factors.…”

“…Overall, the number of patients included in these studies was close to 480 subjects with RA. This review concluded that patients with RA tend to misjudge their risk of developing CV disease, usually underestimating it [ 16 ].…”

“…One of the main factors that helps RA patients adopt a healthier lifestyle is the perception of themselves as individuals at high CV risk [ 15 ]. However, information related to RA patients’ awareness of their high CV risk compared to people without RA is scarce [ 16 ]. Considering that the use of the Systematic Coronary Risk Evaluation (SCORE) model is recommended by the European League Against Rheumatism (EULAR) to classify the CV disease risk of patients with RA into four risk subgroups (low, moderate, high and very high) [ 17 ], we may also use this tool to determine how RA patients perceive their own CV risk, how long it is misjudged, or if it influences their lifestyles.…”

RxIALTA: evaluating the effect of a pharmacist-led intervention on CV risk in patients with chronic inflammatory diseases in a community pharmacy setting: a prospective pre–post intervention study

“…This is consistent with the literature, as it has been reported that the levels of awareness and perceived risk of CVD is low in this patient population. 48 Gaps in care have also been reported when it comes to CV risk assessment. 7 12–14 This also highlights the importance of a systematic and proactive approach towards case finding by pharmacists—as many patients would not know to ask for CV risk assessment.…”

Knowledge of Cardiovascular Disease Risk in Rheumatoid Arthritis Patients Before and After Educational Intervention From a Southeast Asia Country: Malaysia

“…The results were consistent with a systematic review which reported that a high proportion of RA patients were unaware of the association between RA and CVD risk. [ 19 ] Lack of awareness of healthcare providers regarding CVD prevention might result in RA patients’ low level of knowledge about RA-related CVD risk. [ 9 ] One study reported that while 100% of rheumatologists were aware of RA-related CVD risk, half of the general physicians were unaware of the RA-CVD link and acted as a barrier to the translation of knowledge to patients.…”