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Cardiac risk factor awareness and management in patients with systemic lupus erythematosus
Karen H Costenbader1, Elizabeth Wright, Matthew H Liang
1Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA. KCostenbader@Partners.org
Insights
Awareness and management of cardiac risk factors (CRFs) in systemic lupus erythematosus (SLE) patients and physicians are insufficient. Many CRFs are under-recognized and undertreated, despite their significance in SLE patients.
Area of Science:
- Rheumatology
- Cardiology
- Public Health
Background:
- Systemic lupus erythematosus (SLE) significantly increases cardiovascular risk.
- Traditional cardiac risk factors (CRFs) are prevalent in SLE patients.
- Effective management of CRFs is crucial for improving outcomes in SLE.
Purpose of the Study:
- To evaluate patient and physician awareness of CRFs in SLE.
- To assess the documentation and management of CRFs in SLE patients.
- To identify discrepancies in CRF assessment between patients and medical records.
Main Methods:
- A questionnaire was administered to 110 SLE patients regarding CRFs.
- Medical records were reviewed for the presence and management of hypertension, hypercholesterolemia, smoking, obesity, diabetes mellitus, and physical inactivity.
- Interrater reliability between patients and rheumatologists was assessed for specific CRFs.
Main Results:
- Over half of SLE patients reported having two or more CRFs.
- Cholesterol levels were unchecked in 23% of patients; hypercholesterolemia was underreported by patients.
- Physical inactivity was overreported by patients compared to medical documentation, with low interrater reliability for both hypercholesterolemia and inactivity.
Conclusions:
- Recognition, documentation, and management of CRFs in SLE patients are inadequate.
- There are significant gaps in the systematic assessment and treatment of CRFs in this population.
- Improved strategies are needed to address the high burden of CRFs in SLE.
Objective:
To assess awareness and management of traditional cardiac risk factors (CRFs) in patients with systemic lupus erythematosus (SLE) and physicians.
Methods:
SLE patients (n=110) completed a questionnaire concerning CRFs. Medical records were reviewed blinded to questionnaire results for the presence and management of 6 CRFs: hypertension, hypercholesterolemia, smoking, obesity, diabetes mellitus, and physical inactivity.
Results:
Subjects were predominantly female (97%), mean (+/-SD) age was 43.4 years (+/-11.8), mean SLE duration was 15.3 years (+/-7.2), and 51% had > or =2 CRFs by self report. Twenty-three percent had never had their cholesterol levels checked. Hypercholesterolemia was more frequently documented in the medical records than reported by the patient (33% versus 24%). Physical inactivity was more frequently self reported than documented (59% versus 23%). Rheumatologists and patients had low interrater reliability for the presence of hypercholesterolemia (kappa=0.26) and physical inactivity (kappa=-0.02). More than half (58%) of CRFs were treated, and 21% of subjects with elevated cholesterol received a medication.
Conclusion:
Recognition, recording, and management of CRFs falls short given the significance of the problem.
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