Urgent Need for Standardized CVD Screening Among Patients With RA

There is an urgent need for increased awareness and standardized screening for cardiovascular risk factors among patients newly diagnosed with rheumatoid arthritis (RA) and general practitioners (GPs) coordinating their care, according to results of an observational study published in Seminars in Arthritis & Rheumatism.

Systemic inflammation resulting from RA may increase an individual’s risk of developing cardiovascular disease (CVD). Despite this increased risk, standardized management and screening among these patients are lacking. Investigators evaluated patients newly diagnosed with RA for CVD risk and assessed their adherence to preventative medical treatment following screening.

Patients aged at least 40 years with a rheumatologist-confirmed diagnosis of RA were included in the study. Cardiovascular risk screening was conducted at a rheumatology outpatient clinic, within one year of diagnosis. An overview of their CVD risk profile along with a 10-year CVD mortality risk assessment and appropriate advice were provided for all patients and their GPs.

The investigators defined CVD risk as very high (>10%), high (5%-10%), intermediate (1%-5%), and low (<1%). The SCORE1 risk assessment tool was used to calculate the 10-year cardiovascular mortality and morbidity risk.

Patients with high/very-high CVD risk were advised to consult with their GP concerning lifestyle guidelines and the possibility of cardio-preventive medication. At least 3 months after advice was given, GPs of patients at high/very-high risk were contacted to determine if advice had been followed.

A total of 125 patients with RA were included in the study (mean age, 56 years; 78% women; median RA duration at screening, 6 months). Hypertension was found in 46% of patients overall, with 43% of these being women and 57% men. Of the 78% of patients found to have dyslipidemia, 76% were women and 86% were men.  Twenty-one percent of women and 46% of men were current smokers.

Only 4% of women had a high or very-high 10-year CVD mortality risk compared with 50% of men.

Following screening and presentation of results, GPs invited 14/19 patients at high/very-high risk for CVD to schedule a follow-up visit to discuss their risks. Among these, 86% completed follow-up.

While 75% of overall follow-ups resulted in initiation of antihypertensive or statin medications, only 26% of total patients at very-high risk for CVD began taking these medications. The investigators noted that 5% of total patients reported having been previously screened and were currently taking antihypertensives at baseline.

This study was limited by its small sample size and potential overestimation of CVD risks.

The investigators concluded, “While most high risk patients had a follow up consultation by their GP, several patients received no invitation or did not go to their GP of their own volition. [Cardiovascular] risk screening needs to be part of standard care for RA patients, with clear agreement on the responsibilities between primary and secondary care.”