Although the rate of screening for hyperlipidemia in patients with rheumatoid arthritis (RA) did not differ from that in the general population, rates of screening were generally poor, according to study results published in Rheumatology.
Patients with RA have an increased risk for cardiovascular disease compared with the general population. The study results highlight the need to increase awareness of cardiovascular risk in RA and to screen more thoroughly for risk factors such as hyperlipidemia.
The longitudinal study included a population-based cohort of participants with RA in British Columbia between 1996 and 2006 (n=5587) matched with general population controls (n=5613). Participants were followed until 2010. The researchers used administrative data to measure compliance with general population guidelines (lipid testing every 5 years for women ≥50 years and men ≥40 years) after they excluded participants with previous diagnoses of diabetes, coronary artery disease, or hyperlipidemia. They used Chi-square testing to compare compliance rates in RA.
The participants with RA contributed 6993 5-year eligibility periods and the controls contributed 7208 eligibility periods. Of these, lipids were measured in 56.6% of RA eligibility periods and 59.5% of control eligibility periods (adjusted odds ratio, 0.97; 95% CI, 0.90-1.06).
Compared with the general population, screening rates improved over time to 65.8% in 2003 for participants with RA, although that rate is still suboptimal.
The mean compliance rate was 56.6% in participants with RA and 59.5% in controls. Family physicians ordered almost all lipid tests.
The researchers found that living in the Northern Health Authority area, having a higher socioeconomic status, having ≥1 comorbidities, having a hospitalization in the past year, seeing a rheumatologist in the past 5 years, and having no clinician visits in the last year were all significant predictors of not receiving screening. The odds of receiving screening increased until age 58 and then decreased.
“Our results point to the need to communicate to [family physicians] the excess [cardiovascular disease] risk in RA, as per recent quality indicators for cardiovascular care in RA, since we and others have found that [family physicians] order most lipid tests and take responsibility for most primary prevention of RA comorbidities,” the researchers wrote.
Schmidt TJ, Aviña-Zubieta JA, Sayre EC, et al. Quality of care for cardiovascular disease prevention in rheumatoid arthritis: compliance with hyperlipidemia screening guidelines [published online June 27, 2018]. Rheumatology. doi:10.1093/rheumatology/key164