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![Cardiovascular changes associated with AS may begin early in the disease process. Thus, assessment of cardiovascular risk should be routine for all patients affected with this disease. Preventing CVD or cardiovascular death depends on early identification and effective management of traditional cardiovascular risk factors such as hypertension or hypercholesterolemia. Despite their importance, screening and treatment of CVD risk factors in patients with rheumatic diseases are often suboptimal. One reason for suboptimal management may be confusion over who is responsible for monitoring cardiovascular risk in patients with AS.[14] The lack of disease-specific guidelines for risk assessment is another concern. Ensuring patients with AS are screened and managed appropriately for CVD will require collaboration between the rheumatologist or specialist nurse, the general practitioner, and the patient.[14]](https://www.rheumatologyadvisor.com/wp-content/uploads/sites/18/2019/01/8heartmonitorvitalsignsts_1032652.jpg)
Black individuals with rheumatoid arthritis are more likely to have increased rates of cardiovascular risk factors than white individuals, according to a study recently published in Medical Sciences. These risk factors include dyslipidemia, hypertension, diabetes, and obesity. Data underscore the vulnerability of this population and the resultant need for stratified risk management.
This study included 503 individuals with rheumatoid arthritis, 88.5% of whom were black, 29.4% of whom were smokers, and 87.9% of whom were women. All patients were at least 18 years old and seen between 2010 and 2017. Physicians’ notes on consultations, inpatient/outpatient records, and the use of disease-modifying antirheumatic drugs were collected. A musculoskeletal radiologist viewing bilateral hand radiographs was blinded to the individual’s serologic status. To investigate variation in cardiovascular disease outcomes and risk profiles, therapeutic patterns, and features of rheumatoid arthritis disease acuteness, the largely black population was compared with the largely white population of the Consortium of Rheumatology Researchers of North America (CORRONA). Continuous variables were compared between groups using a t-test, whereas a χ2 test was used for categorical variable comparison.
The largely black cohort had higher cardiovascular disease risk factors compared with the CORRONA white cohort, including:
· hypertension (66.6% vs 29%),
· dyslipidemia (41.3% vs 25%),
· smoking (29.4% vs 34%), and
· diabetes (28.5% vs 8%).
At least one usual risk factor was present in 87.4% of participants, whereas at least 3 risk factors were present in 37%, and risk factors specific to rheumatoid arthritis like having a body mass index less than 20, higher presence of inflammatory markers, extra-articular disease, erosion of joints, at least 10 years of disease duration, and seropositive disease were present in 58% of participants. The black cohort also showed increased use of steroids and lower use of biologics.
Limitations to this study include a retrospective design, as well as no available measurements of rheumatoid arthritis-specific disease activity parameters, cardiac involvement data, ischemic vs hemorrhagic stroke, survival outcomes, or therapeutic intervention response.
The study researchers conclude that “[we] observed higher rates of traditional [cardiovascular] risk factors, including obesity, diabetes, hypertension, dyslipidemia, compared to the White RA cohort. Our population had more aggressive disease with higher rates of seropositivity, joint narrowing/erosions and elevated inflammatory markers. The combination of higher rates of traditional and RA-specific risk factors confers on our patients a high risk for [cardiovascular] events. Our RA population characteristics require therapeutic interventions to address disease control and targeted management of comorbidities that involve revised risk stratification aiming at reducing [cardiovascular] morbidity and mortality in this highly vulnerable population.”
Reference
McFarlane IM, Zhaz Leon SY, Bhamra MS, et al. Assessment of cardiovascular disease risk and therapeutic patterns among urban black rheumatoid arthritis patients. Med Sci (Basel). 2019; 7(2):31.
