Suboptimal Cardiovascular Risk Factor Target Attainment in Patients With Antiphospholipid Syndrome vs RA and Diabetes

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Researchers assessed the attainment of traditional cardiovascular risk factor therapeutic goals in patients with antiphospholipid syndrome vs those with rheumatoid arthritis and diabetes mellitus.

In patients with antiphospholipid syndrome (APS) vs those with rheumatoid arthritis and diabetes mellitus (DM), although prevalence of traditional cardiovascular (CV) risk factors is comparable, there is low attainment of CV risk factor targets, according to study results published in Lupus Science & Medicine.

The researchers sought to examine the attainment of traditional CV risk factor treatment goals in patients with APS vs those with RA and DM.

Cardiovascular risk was estimated using the Systemic Coronary Risk Evaluation and CV risk factor therapeutic targets were defined based on European Society of Cardiology (ESC) guidelines. Eligible patients with primary APS or systemic lupus erythematosus (SLE)-related APS (SLE-APS) were classified into 2 subgroups, according to the date of their initial visit to Laiko Hospital: first visit between 2011 and 2015 or between 2016 and 2020. All patients with APS were age- and sex-matched in 1:1 ratio with eligible patients with RA or DM (type 1 or type 2).

The cross-sectional study was conducted among patients in the Greek APS registry and patients in the Greek RA registry. A total of 122 patients with APS, 74 of whom had primary APS and 48 of whom had SLE-APS, were enrolled in the study. Overall, 68% of the participants were women; the mean patient age was 44.5±11.3 years; and all patients were White. The participants were classified into either the 2011 to 2015 APS group or the 2016 to 2020 APS group, with 61 patients enrolled in each of the subgroups.

Although a comparable or higher prevalence of CV risk factors were reported between patients with APS and patients with RA or DM, according to ESC guidelines, a low CV risk factor target attainment was observed among those with APS. Among patients with high-risk and very-high-risk APS in the 2011 to 2015 APS group, 70%, 10%, 40%, 10%, 90%, 30%, 70%, 70%, and 10% attained the smoking, exercise, body mass index, waist circumference, blood pressure, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and 5 CV risk factor goals, respectively, compared with 94%, 24%, 35%, 18%, 65%, 12%, 65%, 59%, and 6%, respectively, in the 2016 to 2020 APS group.

Further, CV risk factor control was significantly worse among patients with APS vs those with RA, with regard to smoking (P =.014), HDL-C (P <.001), waist circumference (P =.042), and 5 CV risk factors (P =.030). Cardiovascular risk factor control also was worse among patients with APS vs those with DM, with regard to exercise (P =.077), although a significantly lower percentage of patients with DM vs those with APS attained the smoking (P =.047) and the LDL-C (P <.001) target goal.

The researchers concluded, “Better understanding of atherogenic — in addition to thrombotic — cardiovascular risk in patients with APS, and development of CV [disease] (CVD)-specific — in addition to thrombotic — risk prediction tools, as well as disease-specific CVD risk management strategies should be included in the future CVD risk management research agenda in APS.”


Bolla E, Tentolouris N, Sfikakis PP, Tektonidou MG. Cardiovascular risk management in antiphospholipid syndrome: trends over time and comparison with rheumatoid arthritis and diabetes mellitus. Lupus Sci Med. 2021;8(1):e000579. doi:10.1136/lupus-2021-000579