Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic

Abstract

Disclosure statement: S. Rollefstad and A. S. Eirheim have no disclosures. T. K. Kvien has received speaker and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer/Wyeth, Roche, and UCB. I. Holme has received speaker honoraria and consulting fees from Pfizer and Merck/Schering Plough and consulting fees from AstraZeneca and Roche. T. R. Pedersen has received speaker honoraria and consulting fees from Pfizer and Merck/Schering-Plough and speaker honoraria from AstraZeneca. A. G. Semb has received speaker honoraria from Merck/Schering Plough, Abbott, Pfizer, BMS and Wyeth, and received speaker honoraria and consulting fee from Abbott and Roche. Objectives: To perform cardiovascular (CV) risk stratification in patients with inflammatory joint diseases (IJD) and treat to lipid targets according to recommendations.Methods: We initiated a preventive cardio-rheuma clinic based on the unmet need of adequate CV prevention in IJD patients. A full CV risk stratification was performed at the first consultation (history of conventional risk factors and of CV disease, lipid measurement, blood pressure and ultrasound examination of both carotid arteries), and the patient was classified to either a primary or secondary CV prevention regime, or to have low risk (no intervention). Lipid lowering (LL) treatment was adjusted until at least two lipid targets were achieved.Results: Of the 426 patients referred, 36.6% had a systematic coronary risk evaluation (SCORE) <5% (no LL intervention). The remaining 270 patients [(rheumatoid arthritis (RA): n=165, ankylosing spondylitis (AS): n=70, and psoriatic arthritis (PsA): n=35] were categorized to either primary (n=63) or secondary prevention (n=207). There were significant differences between the patient groups regarding age (p<0.001), sex (p<0.001) and disease duration (p<0.001). Lipid changes in IJD patients were; total cholesterol: 1.86±1.20 mmol/L (p<0.001), low density lipoprotein cholesterol: 1.74±1.11 (p<0.001), high density lipoprotein cholesterol: -0.01±0.30 (p=0.61), triglycerides: 0.28±0.72 (p<0.001). The proportions of patients reaching at least 2 lipid targets were for RA/AS/PsA: 92.1/90.0/82.9% respectively. No serious adverse events were observed.Conclusions: There was indication for CV prevention in a high proportion of IJD patients referred for CV risk stratification. Treatment to lipid targets was successful in approximately 90% of patients with IJD.

Cardiovascular comorbidity in rheumatic diseases

“…37,33 Evidence suggests that lipid-lowering (statin) therapy is substantially underutilized in patients with RA who fulfill even the general population thresholds for this treatment. 40 This unmet need for management of dyslipidaemia is also seen in patients with other IJDs, 41 and could have adverse consequences in terms of cardiovascular outcome.…”

Adherence to cardiovascular prevention strategies in patients with rheumatoid arthritis

“…In general, over the past 4 weeks, 67 patients (72%) were 'able to do what the doctor told them to do' ('most of the time' to 'always') ( Figure 1E). The median sum score was 5 [interquartile range (IQR) [3][4][5][6][7] in the group with a CVD risk < 10% and 10-19%. The group with a CVD risk ≥ 20% had a median sum score of 4 (IQR 1-8), which was significantly lower than the other groups (p = 0.03).…”

“…There is evidence of underdiagnosis and undertreatment of traditional CVD risk factors in RA patients in both primary (5)(6)(7) and secondary prevention (8). Recent CV risk management guidelines include specific adaptations for RA patients for the calculation of their CVD risk (9,10).…”

Assessment of Cardiovascular Risk in Patients with Rheumatoid Arthritis

“…To address the shortcomings in assessment of CV risk, a very few clinics in North America and Northern Europe have established a so-called "cardiorheumatology clinic" for the specific and directed assessment of CV risk in patients with RA, coupled with integrated risk reduction and management programs 18 . While such efforts hold promise, they may not be practical or affordable in many healthcare settings; nevertheless, they highlight the importance of disease co-management between primary care and rheumatology providers.…”