Recognition and control of hypertension, diabetes, and dyslipidemia in patients with rheumatoid arthritis

Abstract

Absolute cardiovascular risk of an individual with rheumatoid arthritis (RA) is greater when compared to the general population, and several factors have proven to be important for the development of coronary artery disease (CAD) in these patients, including factors related to the underlying disease, such as the systemic inflammatory response, drugs used in its treatment, and a higher prevalence of traditional risk factors for CAD. Our aim is to describe the recognition and control frequencies of systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM) in RA patients. Patients with RA answered a questionnaire focused on their general knowledge of the risk factors for CAD, as well as on the recognition of the risk factors that they possess. The patient's information, collected from a structured medical record, was reviewed to evaluate the control of risk factors. Hundred and thirty-four patients were included in the study. One patient was excluded due to the impossibility of reviewing her medical records. Therefore, 133 patients remained in the study. Patients had a mean (SD) age of 57.3 (12.9) years. SAH was diagnosed in 88 subjects, with a recognition frequency of 89.8%, and 63.3% had desirable blood pressure control. Seventy-two patients were diagnosed with dyslipidemia; 68.1% recognized that they had dyslipidemia and 69.4% achieved desirable LDL-c control. Twenty-two patients had DM; 90.9% admitted being diabetic and 40.9% had desirable glycemic control. The frequencies of the CAD risk factor recognition and control were high in comparison to those described for the general population.

Clinical Inertia in Rheumatology Practice

“…Cardiovascular disease remains a major cause of mortality in patients with RA and Lupus. 19,20 In an international audit involving 19 countries of the management of dyslipidaemia and hypertension in patients with RA, it was noted that the lipid target attainment was only 45% and 18% in the high and very high risk groups respectively and 62% had hypertension, but only approximately half of these patients were attaining target blood pressure. 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.…”

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

“…It may be that hesitation or lower familiarity with comorbidity may lead rheumatologists to “inertia” in refraining from screening and CV prevention. Although, some reports show that CV risk factor recognition and prevention is high [49]. The phenomenon of clinical inertia requires further study in RA.…”

Frequency of dyslipidemia and other cardiovascular risk factors in patients with rheumatoid arthritis

“…Los criterios de inclusión fueron: pacientes con edad mayor de 18 años, con diagnóstico de AR según los criterios de la American Collage of Rheumatology (ACR) (8) . (8) . Los valores de glicemia entre 100 y 125 mg/dL se asumieron como glucosa en ayunas alterado.…”

“…Los pacientes con actividad de la enfermedad muestran un perfil aterogénico aumentado comparado con la población sin AR. Simultáneamente los fármacos utilizados para controlar la actividad de la enfermedad producen una alteración del metabolismo de los lípidos, sobre todo secundario al uso de corticoides (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) .…”