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Rheumatoid Arthritis, Statin Indication and Lipid Goals: Analysis According to Different Recommendations
Walter Masson1, Emiliano Rossi1, Rodolfo N Alvarado2
1Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina.
Insights
Cardiovascular risk assessment in rheumatoid arthritis (RA) patients varied significantly across different strategies, revealing a gap between recommended and actual statin use. Few RA patients met their lipid goals, highlighting a need for improved management.
Area of Science:
- Cardiology
- Rheumatology
- Public Health
Background:
- Rheumatoid arthritis (RA) patients face elevated cardiovascular disease (CVD) risk.
- Current CVD risk management strategies for RA patients require evaluation.
- Discrepancies exist in applying different risk assessment tools and treatment guidelines.
Purpose of the Study:
- To compare cardiovascular risk stratification in RA patients using multiple established strategies.
- To determine the proportion of RA patients eligible for statin therapy under various guidelines.
- To assess the achievement of lipid goals in RA patients based on European recommendations.
Main Methods:
- Cross-sectional study utilizing secondary database.
- Estimation of cardiovascular risk using QRISK-3, Framingham, ASCVD, and SCORE calculators.
- Analysis of statin eligibility based on NICE, Argentine Consensus, ACC/AHA, and European guidelines.
- Evaluation of LDL-C goal attainment according to European guidelines.
Main Results:
- Four different strategies yielded varying cardiovascular risk stratification and statin eligibility.
- Statin eligibility ranged from 18.2% (SCORE) to 41.1% (NICE).
- Under European guidelines, only 15.9% of very high-risk RA patients achieved LDL-C goals.
Conclusions:
- Significant differences exist in cardiovascular risk assessment and statin indication for RA patients across various strategies.
- A notable gap exists between recommended and observed statin prescription rates.
- Current lipid management strategies are insufficient, with a low percentage of RA patients achieving target LDL-C levels.
Background:
Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA).
Objectives:
(1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals.
Methods:
A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor×1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed.
Results:
A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals.
Conclusion:
Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals.
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