E066 Cardiovascular risk scores in Indian patients with rheumatoid arthritis

Misra, Durga Prasanna; Muhammed, Hafis; Pattanaik, Sarit Sekhar; Ganguly, Sujata; Chaturvedi, Saurabh; Singh, Harshinder; Mohit, K; Anuja, Anamika Kumari; Mohindra, Namita; Jain, Neeraj; Kumar, Sudeep; Agarwal, Vikas

doi:10.1093/rheumatology/kez110.064

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“…'QRISK-3' has also been specifically recommended for the patients of Indian ethnicity. 37 In conclusion, this preliminary work demonstrates that the treating rheumatologists may not be critically and frequently examining the atherogenic lipid profile of the patients with RA (and possibly other RMDs) and educating them regarding ASCVD and the need for prevention with appropriate drug treatment. This study also brings out a clear discrepancy between the recommended lower target level of hs-CRP for ASCVD prevention (<2 mg/l) versus the permitted level of hs-CRP <10 mg/l in the definition of remission in RA.…”

Section: Discussionmentioning

confidence: 86%

“…This choice was based upon its specific utility for rheumatic and musculoskeletal diseases, including RA, as also in systemic lupus erythematosus (SLE) 36 that have been factored in its calculations and found to have maximum utility in Indian patients with RA to predict subclinical atherosclerosis. 37 Using the ‘QRISK-3’ calculator, 10-year risk for ASCVD was calcu-lated and the patients were categorised under the following ASCVD-risk categories: ‘ Very High Risk ’: QRISK-3 score ‘>20%’ 10-years ASCVD risk or, clinically diagnosed/established ASCVD on treatment, bypass surgery done, or coronary stenting done—under cardiology follow-up. ‘ High Risk ’ for ASCVD: Do not have clinically established ASCVD, but QRISK-3 score ‘10- to <20%’ 10-year ASCVD risk. ‘ Moderate ASCVD risk ’: Do not have clinically established ASCVD, but QRISK-3 score ‘5- to <10%’ 10-year ASCVD risk. ‘ Low ASCVD risk ’: Do not have clinically established ASCVD, QRISK-3 score ‘<5%’ 10-year ASCVD risk. …”

Section: Methodsmentioning

confidence: 99%

“…This choice was based upon its specific utility for rheumatic and musculoskeletal diseases, including RA, as also in systemic lupus erythematosus (SLE) 36 that have been factored in its calculations and found to have maximum utility in Indian patients with RA to predict subclinical atherosclerosis. 37 Using the 'QRISK-3' calculator, 10-year risk for ASCVD was calculated and the patients were categorised under the following ASCVD-risk categories: In the second step, the patients were prescribed lipid-lowering drugs to achieve the following targets of LDL-C stratified in different risk categories as has been recommended by the Indian guidelines for lipid control: 17,18 • In those at 'very high ASCVD risk' LDL-C target to be achieved was <50 mg/dl.…”

Section: Treatment For Lipid Controlmentioning

confidence: 99%

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Prevention of Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Persistent Low-grade In-flammation May be an Impediment Needing Attention

Malaviya,

Bondge,

Prasad

2024

Indian Journal of Rheumatology

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Objective: To determine the status of ‘residual inflammatory risk’ (RIR) and ‘residual cholesterol risk’ (RCR) in patients with Rheumatoid Arthritis (RA) in remission with the aim of estimating their atheroscle-rotic cardiovascular disease (ASCVD) risk. Methods: The study included patients with RA in remission during their last two clinic visits on treatment with disease- mod-ifying anti-rheumatic drugs (DMARDs). Using the QRISK-3 calculator, participants were stratified into four risk categories for ASCVD: ‘Very high’, ‘High’, ‘Moderate’, and ‘Low’. Patients were prescribed lipid-lowering drugs targeting low-density lipoprotein cholesterol (LDL-C) levels to <50 mg/dl, <70 mg/dl, <100 mg/dl or <130 mg/dl, respectively. Those with a history of ASCVD before or during the follow-up period was excluded from the study. Multimorbidity were also recorded in all the patients. Results: The study included 130 patients with RA in remission. The results showed that despite being in remission and taking treatment for lipid control, 81 (62%) and 91 (70%) patients still had ‘RIR’ and ‘RCR’, respectively. Hypertension, hypothyroidism, type-2 diabetes mellitus and obesity were the common multimorbidity. Conclusions: Persistent RIR in 62% of patients despite being in remission, could possibly be due to the current ‘liberal’ definition of RA permitting hs-CRP level up to <10 mg/l, which is five-fold higher than the recommended <2 mg/l for ASCVD prevention. Hence it may be necessary to revise the definition of ‘remission’ in RA factoring in the suggested lower level of hs-CRP. Additionally, rheumatologists might need to be more vigilant in lipid management with appropriate patient education regarding RCR.

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Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

“…This choice was based upon its specific utility for rheumatic and musculoskeletal diseases, including RA, as also in systemic lupus erythematosus (SLE) 36 that have been factored in its calculations and found to have maximum utility in Indian patients with RA to predict subclinical atherosclerosis. 37 Using the 'QRISK-3' calculator, 10-year risk for ASCVD was calculated and the patients were categorised under the following ASCVD-risk categories: In the second step, the patients were prescribed lipid-lowering drugs to achieve the following targets of LDL-C stratified in different risk categories as has been recommended by the Indian guidelines for lipid control: 17,18 • In those at 'very high ASCVD risk' LDL-C target to be achieved was <50 mg/dl.…”

Section: Treatment For Lipid Controlmentioning

confidence: 99%

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