Use of Lipid-lowering Agents in Rheumatoid Arthritis: A Population-based Cohort Study

Abstract

Objective Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease and mortality. Lipid-lowering therapy is reportedly underused in patients with RA. However, longitudinal cohort studies comparing the use of lipid-lowering medications in patients with RA vs the general population are lacking. Methods Cardiovascular risk factors, lipid measures and use of lipid-lowering agents were assessed in a population-based inception cohort of patients with RA and a cohort of non-RA subjects followed from 1/1/1988 to 12/31/2008. The National Cholesterol Education Program (NCEP) adult treatment panel III (ATP III) guidelines were assessed at the time of each lipid measure throughout follow-up. Time from meeting guidelines to initiation of lipid-lowering agents was assessed using Kaplan-Meier methods. Results The study population included 412 RA and 438 non-RA patients with ≥1 lipid measure during follow-up and no prior use of lipid lowering agents. Rates of lipid testing were lower among patients with RA compared to non-RA subjects. Among patients who met NCEP ATP III criteria for lipid-lowering therapy (n=106 RA and n=120 non-RA), only 27% of RA and 26% of non-RA subjects initiated lipid-lowering agents within 2 years of meeting guidelines for initiation. Conclusions There was substantial undertreatment in both the RA and non-RA cohorts who met NCEP ATP III criteria for initiation of lipid-lowering agents. Patients with RA did not have as frequent lipid testing as individuals in the general population.

Application of the European Society of Cardiology, Adult Treatment Panel III and American College of Cardiology/American Heart Association guidelines for cardiovascular risk management in a French cohort of rheumatoid arthritis

“…Although cardiovascular disease contributes to half of the mortality occurring during RA [1], lipid-lowering agents are underused in RA despite management guidelines to reduce LDLc levels as recommended by ATP III [28,29]. In the present RA cohort, only 17.7% of patients aged 40 to 65 and 25.8% of patients over the age of 65 received a statin, while [31].…”

Drug prescribing trends in adults with rheumatoid arthritis: a population-based comparative study from 2005 to 2014

“…This is concerning as patients with RA are at increased risk for cardiovascular events and are often at sufficiently high risk to require statin therapy [13] [22]. A previous study from this same population found that patients with RA were not adequately initiated on lipid lowering therapy when they met clinical guidelines set by the National Cholesterol Education Program (NCEP) and their lipids were tested less frequently than individuals from the general population [23]. …”

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

“…Assessment of adherence to cardiovascular disease quality indicators at two Canadian university clinics showed low performance rates for several measures 154. Moreover, rheumatoid arthritis patients are less likely than other patients to have lipid measurements obtained,155156 with less than 50% of eligible rheumatoid arthritis patients in the 5% random sample of Medicare receiving appropriate lipid screening 157. Use of lipid lowering treatment for rheumatoid arthritis patients fulfilling the National Cholesterol Education Program’s Adult Treatment Panel III criteria was suboptimal, with only 27% starting therapy 155.…”

“…Moreover, rheumatoid arthritis patients are less likely than other patients to have lipid measurements obtained,155156 with less than 50% of eligible rheumatoid arthritis patients in the 5% random sample of Medicare receiving appropriate lipid screening 157. Use of lipid lowering treatment for rheumatoid arthritis patients fulfilling the National Cholesterol Education Program’s Adult Treatment Panel III criteria was suboptimal, with only 27% starting therapy 155. In a separate cross sectional study, 38% of rheumatoid arthritis patients without previous cardiovascular disease were deemed at risk, and yet only 7% were receiving statins 158.…”