Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit

Abstract

AimThe objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention.MethodsThe cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM.ResultsThe study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM.ConclusionCVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA .

Insulin resistance and adverse lipid profile in untreated very early rheumatoid arthritis patients: A single-center, cross-sectional study in China

“…29,30 Recently, a study emphasized the importance of diabetes mellitus and cardiovascular risk management in patients with RA, and moreover, the authors pointed out that experience could be learnt from cardiovascular disease prevention programs to benefit RA patients. 31 Similar to the findings in previous reports, DAS28 and CRP were found to be positively correlated with IR, 32 and demonstrated to be independent predictors in logistic regression analysis in the present study. A positive association between ESR and IR was observed, but it was not an independent risk factor for IR, maybe due to relatively small sample size.…”

“…[ 29 , 30 ] Recently, a study emphasized the importance of diabetes mellitus and cardiovascular risk management in patients with RA, and moreover, the authors pointed out that experience could be learnt from cardiovascular disease prevention programs to benefit RA patients. [ 31 ]…”

Clinical Inertia in Rheumatology Practice

“…21 In another study, atherosclerotic cardiovascular disease (ASCVD) was present in 26.7% of patients with RA and DM, compared with 11.6% without DM, indicating the need for effective control of risk factors. 22 Inertia in controlling these risk factors and providing adequate screening for cardiovascular illness results in poorer outcomes.…”

Rheumatoid Arthritis Treatment Options and Type 2 Diabetes: Unravelling the Association

“…Multiple features may be associated with occurrence of T2D in the context of RA [ 5 , 15 , 16 ]. Inactivity, disability, sedentary behaviour, obesity, and glucocorticoid (GC) therapy are known to negatively affect the glucose metabolism and to favour the occurrence of T2D [ 35 ].…”

“…Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by synovitis, cartilage damage, and bone erosions, which is associated with an increased morbidity and mortality compared with the general population [1]. Patients with RA are burdened by an increased risk of accelerated atherosclerosis and cardiovascular disease (CVD) [2][3][4][5]. This finding is partially explained by the enhanced prevalence of "traditional" cardiovascular (CV) risk factors, including smoking habit, overweight, lipid metabolism alterations, high blood pressure, and glucose derangement.…”