Cardiovascular risk assessment in idiopathic inflammatory myopathies: a multicentre international study by the
Athena Chin1, Lekshmi Minikumari Rahulan2, Devansh Lalwani3
1Department of Rheumatology, Flinders Medical Centre, Bedford Park, South Australia, Australia.
Insights
Over a third of patients with idiopathic inflammatory myopathies (IIM) face moderate-high cardiovascular disease (CVD) risk. Adherence to CVD risk assessment and statin guidelines is lacking, despite steroid use and dyslipidemia being significant predictors.
Area of Science:
- Rheumatology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) is a major cause of death in idiopathic inflammatory myopathies (IIM).
- Current cardiovascular risk assessment tools may underestimate risk in IIM patients.
- Guidelines recommend regular CVD risk assessment and statin use for primary prevention.
Purpose of the Study:
- To audit cardiovascular risk assessment in a multinational IIM cohort.
- To evaluate adherence to British Society for Rheumatology (BSR) and National Institute for Health and Care Excellence (NICE) guidelines.
- To identify risk factors for CVD in IIM patients.
Main Methods:
- Multi-centre, international retrospective chart review (2020-2023).
- Evaluation of CVD risk using WHO charts and QRISK3 score.
- Assessment of adherence to BSR and NICE guidelines.
Main Results:
- 336 IIM patients included; most centers lacked routine CVD risk assessment.
- Over a third of patients had moderate-high CVD risk (QRISK3).
- Only 34% of moderate-high risk patients received statins.
- Immune-mediated necrotizing myopathy, active steroid use, and dyslipidemia were associated with higher risk.
Conclusions:
- A significant proportion of IIM patients are at increased risk of CVD.
- Steroid use and dyslipidemia are key modifiable risk factors.
- There is suboptimal adherence to CVD risk assessment and primary prevention guidelines in IIM patients.
Introduction And Aims:
Cardiovascular disease (CVD) is a leading contributor of morbidity and mortality in patients with idiopathic inflammatory myopathies (IIM). The British Society for Rheumatology (BSR) 2022 guidelines recommend that IIM patients should undergo a regular cardiovascular risk assessment; however, many tools underestimate scores in IIM due to their sole focus on traditional risk factors. Cardiovascular Risk Score (QRISK) incorporates risk factors that are more relevant in IIM, such as corticosteroid use. The National Institute for Health and Care Excellence (NICE) guidelines recommend offering statin therapy for the primary prevention of CVD in patients with an estimated 10-year CVD risk of ≥10 %. This study aimed to undertake an audit of cardiovascular risk assessment in a multinational cohort of patients with IIM, based on BSR and NICE recommendations.
Methods:
A multi-centre, international retrospective chart review was conducted in IIM cohorts from centres in India, Hong Kong, Brazil, Italy, Australia, and the United Kingdom, of patients who attended clinics between 2020 and 2023. Data were collected from medical records to evaluate CVD risk using both WHO cardiovascular risk charts and QRISK3 score. Based on their risk of cardiovascular events in the next 10 years, patients were defined as high-risk (>20 %), moderate-risk (10-20 %), or low-risk (<10 %). Adherence to the BSR and NICE guidelines was evaluated.
Results:
A total of 336 patients were included. All centres, except one, did not routinely assess CVD risk. More than a third of patients were deemed moderate-high risk for CVD as per QRISK3, although only 34 % in this group were prescribed a statin as per NICE guidelines. Disease subtype immune-mediated necrotizing myopathy was strongly associated with moderate-high risk scores (OR = 4.64; 95 %CI = 1.88-11.45, p < 0.001), as was active steroid use [OR = 1.76 (95 % CI = 1.06-2.92), p = 0.03] and dyslipidaemia [OR = 1.22 (95 % CI = 1.03-1.45), p = 0.02]. There was a moderate level of agreement between WHO and QRISK3 scores.
Conclusion:
Over a third of patients with IIM are at moderate-high-risk of cardiovascular events in 10 years. Steroid use and dyslipidaemia were modifiable risk factors that were statistically significant predictors of risk. Despite this, there is a lack of adherence to current guidelines advising regular CVD risk assessment and use of statins for primary prevention in this moderate-high risk group.
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