THU0081
ASSESSING THE CARDIOVASCULAR RISK BURDEN IN PATIENTS WITH RHEUMATOID ARTHRITIS: ROLE OF ANNUAL REVIEW CLINIC
V. Patel 1,*U. Karjigi 2R. Abernethy 1J. Dawson 1 and Adrian Clewes, Jacqueline Novak, Angela Cox, Janet Williams, Tracey O'Rourke- Rheumatology Department at ST Helens and Whiston Hospital NHS Trust
1Rheumatology, 2National Helath Service, Uk, St Helens, United Kingdom
Background: Rheumatoid arthritis(RA) is associated with the increased risk of cardiovascular (CV) mortality and morbidity [1]. There are recommendations by European League against Rheumatism (EULAR) and National Institute for Health and Clinical Excellence (NICE) to include assessment of cardiovascular, osteoporosis, infection and depression risks annually [2,3]. One of the ways CV risk is calculated is by assessing the 10-year risk of having CV event [4].
Objectives: The objective was to determine the relationship of the traditional CV risk factors and compare with RA patients on disease modifying agents (DMARDs) and biologics therapy.
Methods: Data was collected retrospectively using a standardised data collection tool for all the 231 patients who attended the annual review clinics in the last 4 year from Aug 2006 to Aug 2011. Data was analysed by Fisher Exact test for discrete values and unpaired t-test for non-discrete values.
Results: The demographic characteristics of patients are shown in the table 1.
Characteristics |
Numbers (N= 231) |
Percentages/ range |
|
Male: Female |
65: 165 |
28%: 72 % |
|
Average Age |
62 yrs |
22 to 85 years |
|
Rheumatoid factor positive |
123 |
53% |
|
Anti-CCP positive |
64 |
28% |
|
DAS-ESR >3.2 |
72 |
31% |
|
Extra-articular features |
127 |
55% |
The prevalence of various risk factors and CV risk in biological and DMARD patients are mentioned in table 2.Table 2:
CV risk prevention |
Total |
DMARD Pt. (n=164) |
Biologics Pt (n=67) |
P value |
|
Age >50 years |
Average |
66 |
58 |
0.0001 |
|
Male gender |
65(28%) |
54 |
11 |
0.01 |
|
Hypertension |
81(35 %) |
58 (35%) |
23 (34%) |
1.00 |
|
Diabetes Mellitus |
19 (8%) |
10 (6%) |
9 (13%) |
0.10 |
|
Currently smoking |
40(17%) |
25 (15%) |
15 (22%) |
0.24 |
|
Aspirin therapy |
30 (13%) |
17 (10%) |
13 (19%) |
0.08 |
|
Statin therapy |
48(21%) |
33 (20%) |
15 (22%) |
0.72 |
|
TC/HDL Ratio> 6 |
4 (2%) |
3 (2%) |
1(1%) |
1.00 |
|
CV risk >20% |
54(23.3%) |
49 (30%) |
5 (7%) |
0.0001 |
Conclusions: A multi-disciplinary annual review clinic allows assessing and predicting the CV risks. Our audit shows CV risk is prevalent in RA patients treated with DMARDS, which warrants regular screening. The CV risk was 23% in overall patients and it was 7% and 30% in biologics and DMARD patient’s respectively. This is the first study to show reduced CV risk in patients treated with biological therapy, most probably through the known beneficial effects on metabolism. We need further studies to confirm that the patients on biologics have lesser CV risk and to see if this translates into reduced cardiovascular disease in the long term.
References: 1.
Aho K, HeliovaaraM. Risk factors for rheumatoid arthritis. Ann Med 2004; 36:242–51.
2.
Peters MJ et al: EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010, 69:325–31
3.
NICE guidelines: www.nice.org.uk/CG67
4.
JBS 2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005;91(Suppl. 5):V1–52.
Disclosure of Interest: None Declared