NIV Congres

Introduction: Rheumatoid arthritis (RA) is recognized as an independent cardiovascular risk factor. The ongoing inflammatory state in RA is believed to be the main cause of this increased cardiovascular risk. However, there is evidence for underdiagnosis and undertreatment of traditional cardiovascular risk factors in patients with RA, which potentially contributes to the overall cardiovascular risk in RA patients. The recently published Dutch multidisciplinary guideline for cardiovascular risk management (CVRM) advises aggressive treatment of traditional cardiovascular risk factors in RA.

Aim of the study: To investigate the prevalence of underdiagnosis and undertreatment of traditional cardiovascular risk factors in RA patients according to the CVRM guideline.

Material and Methods: RA patients up to 70 years of age without cardiovascular disease (AMI, PTCA, CABG, CVA, TIA, severe claudicatio, PTA and/or amputation due to arterial vascular disease) and/or diabetes mellitus were included. Patients underwent a standard physical examination, including systolic blood pressure (sBP) and the rheumatoid arthritis activity score (DAS28). Standard laboratory measurements including a fasting lipid profile were measured.

Results: 5 (2%) of 315 referred patients were diagnosed with de novo type 2 diabetes mellitus. 310 patients were included with a mean (± SD) age of 53.3 ± 11.3 years and a mean (± SD) disease duration of 9.58 ± 8.99 years. The mean (± SD) DAS28 was 2.43 ± 1.06 reflecting low disease activity. 68% of the patients were female (n = 212). 55 (17%) patients were already known with hypertension. 37 (67%) were inadequately treated (sBP ≥ 140 mmHg) despite antihypertensive treatment. A sBP > 140 mmHg was observed in 80 (32%) RA patients without prior hypertension. The mean LDL-C (± SD) levels were 3,4  ± 0,9 mM for those without lipid lowering therapy and 3,0  ± 1,1 mM for the patients who received statin therapy (n = 14). A total of 80% of RA patients showed a LDL-C ≥ 2.5 mM, which has been recommended as treatment target.

Conclusion: Almost two thirds of the RA patients with hypertension did not reach treatment targets and a sBP > 140 mmHg was observed in one third of the RA patients without a prior diagnosis of hypertension. The new advised treatment target for hypercholesterolemia in RA was only met by 20% of the patients. Our study suggests that there is a marked underdiagnosis and undertreatment of hypertension and hypercholesterolemia in RA patients. There is need for improved cardiovascular risk assessment in RA patients.