Applying 4 different strategies for cardiovascular risk stratification and indications for statin treatment showed considerably different results in patients with rheumatoid arthritis (RA), according to study results published in Rheumatologia Clinica.
Because RA is associated with increased cardiovascular morbidity and mortality, several strategies have been proposed to optimize cardiovascular risk stratification in this patient population. The current study aimed to determine the cardiovascular risk by different strategies in patients with RA, assess the indications for statin therapy, and assess how many patients meet the recommended lipid goals.
The cross-sectional study included adults fulfilling the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA. In patients without cardiovascular disease, 4 different cardiovascular 10-years risk scores were calculated, including the QRISK-3, used by the National Institute for Health and Care Excellence (NICE) guidelines; the Framingham score, according to the Consensus of Argentine Society of Cardiology; the atherosclerotic cardiovascular disease (ASCVD) calculator, used by the American College of Cardiology/American Heart Association (ACC/AHA); and the Systematic Coronary Risk Evaluation (SCORE), used by the European Society of Cardiology (ESC) guidelines.
Researchers also analyzed the indications for statin therapy and the recommended low-density lipoprotein cholesterol (LDL-C) goals, using the NICE, Argentine Consensus, ACC/AHA, and new European guidelines.
The study sample included 420 patients (mean age, 69.7±13.8 years; 85.5% women). Median QRISK-3 values were 17.6%, and 79.2% of patients were classified as “at risk,” following the recommendations of the NICE guidelines. Median adjusted Framingham score was 12.0%; and according to the Argentinean Consensus, 22.1%, 23.7%, and 54.2% of the patients were classified as low, moderate, or high risk, respectively. Median ASCVD risk calculator was 8.2%; and according to the ACC/AHA guidelines, 20.6%, 6.9%, 27.0%, and 45.5% of the patients were classified as low, borderline, moderate, or high risk, respectively. Median SCORE risk was 1.0%.
Treatment with statins was more commonly used for secondary vs primary prevention (48.7% vs 24.7%; P <.001). However, high-intensity statins were used for only 19.4% of patients with cardiovascular history.
Approximately 1 in 4 patients with RA not receiving statins was eligible for treatment according to the ASCVD score (26.9%) and the adjusted Framingham score (26.5%). Using NICE guidelines, 41.1% of patients were eligible for statin therapy, while they were recommended for only 18.2% of patients using the SCORE tool.
With regard to the new Working Group of the ESC recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high, or very high risk, respectively, achieved the suggested lipid goals.
“Applying  strategies for lipid management in our population, the indication for statins was considerably different. However, a significant gap was observed when comparing the expected and observed statin indication, with very few patients achieving the LDL-C goals. Interdisciplinary work between rheumatologists, cardiologists and clinicians could improve these results,” the researchers concluded.
Masson W, Rossi E, Alvarado RN, et al. Rheumatoid arthritis, statin indication and lipid goals: analysis according to different recommendations. Rheumatol Clin. Published online March 18, 2021. doi:10.1016/j.reuma.2021.02.002