AB0355 CURRENT CARDIOVASCULAR RISK (MANAGEMENT) IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS

Background

Patients with rheumatoid arthritis (RA) are at an increased risk for developing cardiovascular diseases. While advice regarding cardiovascular risk screening and management in RA patients has been incorporated in several guidelines in recent years, its implementation and adherence is still poor (1, 2).

Objectives

To assess the cardiovascular disease risk in patients with newly diagnosed RA, and evaluate whether advice to initiate preventive medical treatment of high risk patients was followed.

Methods

All patients with RA, aged 40-70 years, are screened for cardiovascular diseases and risk factors within the first year after diagnosis at the outpatient rheumatology clinic of Reade, as part of standard care. Screening included a physical examination with blood pressure measurement, and laboratory tests with lipid profile tests. All patients and their general practitioner (GP) received an overview with their cardiovascular risk profile and calculated 10-year cardiovascular mortality risk. Risk was defined as low (<1%), intermediate (1-5%), high (5-10%) and very high (>10%).The national pharmacy network was consulted to check whether or not patients started preventive medication after screening.

Results

A total of 125 RA patients were included in this study. The mean age was 56 years and 78% was female. Median RA disease duration at screening was 6 months. 6 patients (5%) indicated to have been screened before, and used antihypertensive medication. During screening, hypertension was found in 46% of patients, with 57% occurring in men and 43% in women. Dyslipidemia was found in 33% of patients, with 36% in male patients and 32% in female patients. 21% of female patients and 46% of male patients currently smoked. Hypertension and dyslipidemia are shown in Table 1. A low 10-year cardiovascular mortality risk was found in 36% of patients, an intermediate risk in 49%, a high risk in 11% and a very high risk in 4% of patients (Figure 1). Only 26% of high and very high risk patients started antihypertensive or statin medication after screening.

Conclusion

An increased cardiovascular disease risk in RA patients, especially male patients, is often present soon after diagnosis, with a large proportion having undiagnosed and untreated hypertension and hypercholesterolemia. Even with structural screening and informing the GP, treatment of cardiovascular risk factors in high risk patients remains insufficient. Obviously, a better collaboration between GPs and rheumatologists is urgently needed to lower the cardiovascular burden of our patients.

References

[1] Agca R et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17-28. [2] van den Oever IAM et al. Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the Implementation of Cardiovascular Risk Management in Rheumatoid Arthritis project. Rheumatology (Oxford). 2017;56(9):1472-8.

Acknowledgements:

NIL.

Disclosure of Interests

Reinder Raadsen: None declared, Romy Hansildaar: None declared, Arno Van Kuijk: None declared, Michael T Nurmohamed Speakers bureau: Abbvie, Janssen, Celgene, Consultant of: Abbvie, Grant/research support from: Abbvie, Amgen, Pfizer, Galapagos, BMS.