SAT0114 Poor cardiovascular risk management in rheumatoid arthritis patients despite an explicit cardiovascular risk management program

Abstract

BackgroundIn 2011, we started a cardiovascular (CV) risk management program for rheumatoid arthritis (RA) patients visiting Reade in the Netherlands. We previously reported the presence of under treatment of hypercholesterolemia and hypertension [1].ObjectivesTo assess the effectiveness of our CV risk management program after one year.MethodsCV risk screening was performed at baseline and we informed the general practitioner (GP) about the results, including advices regarding the initiation of cardio preventive drugs. In high risk patients, antihypertensives were recommended when systolic blood pressure >140 mm/Hg and statins were recommended when low-density lipoprotein >2.5 mmol/l. The decision to start preventive medication was left to the GP. CV risk screening was repeated after one year. Patients completed a questionnaire about the actions that were taken following the results of the initial screening.ResultsOf the 266 patients 202 (76%) were female, the mean age was 58±11 years. After one year, 88 out of 134 patients who received inadequate or no treatment at baseline were still untreated or undertreated. Of the 188 (71%) patients who were at high CV risk and who did have an indication to start therapy, only 7.5% was contacted by their GP and another 6.8% arranged an appointment themselves. While the 10-year CV risk did not decrease in the group as a whole, a risk reduction was found in the patients that started medication. Remarkably, 42% of patients reported lifestyle changes, including more exercise (20%), diet adaption (16%) and weight loss (9%).Table 1.Cardiovascular risk factors at baseline and after one yearBaselineFollow-up CV disease history20 (7.5)23 (8.6)CV risk <10%43 (16.2)52 (19.5)*CV risk 10–20%60 (22.6)62 (23.3)CV risk >20%143 (53.8)129 (48.5)*SBP in mm/Hg135±17135±18Body Mass Index in kg/m226.4±5.026.3±4.8TC in mmol/l5.5±1.05.2±1.0**Triglycerides in mmol/l1.4±0.81.4±0.8LDL-cholesterol in mmol/l3.2±0.93.0±0.9**HDL-cholesterol in mmol/l1.6±0.51.6±0.5TC/HDL-ratio3.7±1.23.7±1.2**Current smokers60 (22.6)53 (20.1)Diabetes mellitus12 (4.5)12 (4.5)SBP >140 mm/Hg95 (35.7)96 (36.2)LDL >2,5 mmol/l208 (78.8)180 (68.4)**TC ≥6.5 mmol/l37 (13.9)26 (9.8)Antihypertensives81 (30.5)88 (33.1)Statins38 (14.3)57 (21.4)**CV = Cardiovascular, HDL = high-density lipoprotein, LDL = low-density lipoprotein, TC = total cholesterol, SBP = Systolic blood pressure. Results are presented as mean ± standard deviation or n, (%). *p<0.05, **p<0.01.ConclusionsIt is striking that one year after the introduction of our CV risk management program, only 14,3% patients with an indication for preventive treatment visited their GP and only 14% started with CV risk lowering drugs. This is mainly caused by the small percentage of high risk patients that contacted their GP. On the other hand, a high percentage reported the start of healthy lifestyle. These results underscore the need for a short-term follow-up, in close collaboration with primary care providers to ensure appropriate CV risk management. This is a future implementation p...