Cardiovascular risk factor management in patients with RA compared to matched non-RA patients

Abstract

Objective. RA is associated with a 50–60% increase in risk of cardiovascular (CV) death. This study aimed to compare management of CV risk factors in RA and matched non-RA patients. Methods. A retrospective cohort study was conducted using UK clinical practice data. Patients presenting with an incident RA diagnosis were matched 1:4 to non-RA patients based on a propensity score for RA, entry year, CV risk category and treatment received at index date (date of RA diagnosis). Patients tested and treated for CV risk factors as well as those attaining CV risk factor management goals were evaluated in both groups.Results. Between 1987 and 2010, 24 859 RA patients were identified and matched to 87 304 non-RA patients. At index date, groups had similar baseline characteristics. Annual blood pressure, lipids and diabetes-related testing were similar in both groups, although CRP and ESR were higher in RA patients at diagnosis and decreased over time. RA patients prescribed antihypertensives increased from 38.2% at diagnosis to 45.7% at 5 years, from 14.0 to 20.6% for lipid-lowering treatments and from 5.1 to 6.4% for antidiabetics. Similar treatment percentages were observed in non-RA patients, although slightly lower for antihypertensives. Modest (2%) but significantly lower attainment of lipid and diabetes goals at 1 year was observed in RA patients.Conclusion. There were no differences between groups in the frequency of testing and treatment of CV risk factors. Higher CV risk in RA patients seems unlikely to be driven by differences in traditional CV risk factor management.

Cardiovascular risk assessment and treatment in chronic inflammatory disorders in primary care

“…Alemao et al 10 found no substantial difference in the assessment, treatment and attainment of CV risk factor goals among a representative sample of patients with RA and non-RA matched controls. Similarly, Monk et al 15 identified similar rates of CVD screening among patients with RA and age-matched, gender-matched and practice-matched non-RA patients.…”

“…Our study findings for significant differences in assessment and treatment of CV risk factors between patients with RA and matched controls imply that at a more local-level important differences may be observed. The Lambeth DataNet is a local dataset and it may have picked up on differences that nationwide datasets10 may have overlooked. Our study findings are in line, however, with recent European and US-based evidence 16–18…”

“…This evidence is less available within a primary care context—the main setting for CVD risk assessment and treatment in the UK. Recently, Alemao et al 10 found no differences in the assessment and treatment of CV risk factors among patients with RA in a large primary care database. The extent to which national recommendations are implemented at a more local level or across different inflammatory disorders is less explored.…”

The Effect of Golimumab on Arterial Stiffness in Patients With Rheumatoid Arthritis

“…В настоящее время не вызывает сомнений, что рев-матоидный артрит (РА) характеризуется высоким риском сердечно-сосудистых осложнений (ССО) и кардиоваску-лярной летальности, превышающей на 48% уровень в об-щей популяции и сопоставимой с таковой у пациентов с сахарным диабетом (СД) 2-го типа [1,2]. Важно отме-тить, что наиболее часто ССО развиваются у больных РА с низким или умеренным кардиоваскулярным риском (КВР), согласно существующим стандартным методам его определения, но с высокой клинико-иммунологической активностью болезни [3].…”

Субклиническое Поражение Магистральных Артерий При Ревматоидном Артрите И Иммунологические Маркеры Метаболизма Костной Ткани

“…Следует отметить, что раннее развитие РА-ассоциированного атеросклероза достаточно часто возникает у лиц, не имеющих классических факторов сердечно-сосудистого риска (в 30-40% случаев) [5], и в значительной степени определяется активностью заболевания, проводимой тера-пией, которые также вносят существенный вклад в развитие остеопороза у этой категории больных. У пациентов с остеопорозом имеется более высокий риск сердечно-сосудистых заболеваний, чем у лиц со здоровой костной тканью [31].…”