Rheumatology Advisor spoke with Eric L. Matteson, MD, MPH, professor of medicine at the Mayo Clinic Minnesota and the president of the Rheumatology Research Foundation, about the pressing need for improved evidence-based risk assessment algorithms for cardiovascular disease assessment in rheumatic diseases. 

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We know that patients with rheumatoid arthritis, as patients with other rheumatic diseases, are at higher risk for cardiovascular diseases. We know that traditional risk factors for cardiovascular disease such as smoking, hypertension, obesity, and hyperlipidemia are factors that affect patients with rheumatoid arthritis, just as they affect people who don’t have rheumatoid arthritis. 

Above and beyond that, however, patients with rheumatoid arthritis are also at higher risk of cardiovascular disease simply based on the fact that they have rheumatoid arthritis, probably because of the inflammatory component of the disease. This is little recognized and is something that we are working to build into risk assessment for cardiovascular diseases among our patients who have rheumatic disease. 

Traditionally, what we have done is to assess for risk factors like smoking, obesity, and so on, as I’ve mentioned.  But now what we are trying to do is to further identify these patients for interventions. One thing that has become really clear through our population-based studies is that patients with rheumatoid arthritis don’t even receive statin therapies when they should be receiving them, so 50% of patients with rheumatoid arthritis who should be on a statin for managing their hyperlipidemia are not on statin therapy. 

Further, the fact that the disease, rheumatoid arthritis, and the inflammatory condition that affects the joints also affects blood vessels and coronary arteries is a contributor toward this risk for cardiovascular disease means that we need to develop better risk assessment tools. 

The finding that we have so far is that the risk assessment tools that are available—the Framingham risk assessment tool or even the multiplication factor that EULAR uses (1.5-times the Framingham score after 10 years of disease)—are inadequate for predicting cardiovascular disease risk in these patients. So we are working very hard to find better assessment algorithms and better assessment tools so that we can identify these patients.

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