Cardiovascular risk goal attainment in the United States rheumatologic population

Rheumatologic diseases are independently linked to premature cardiovascular (CV) events. The emerging field of cardio-rheumatology addresses the intersection of inflammation and accelerated atherosclerosis driving excess CV risk. Despite calls to action, data on risk factor optimization, antihyperlipidemic therapy, and comorbidities remain limited. Using the largest US analytic cohort to date, we examined antihyperlipidemic prescription patterns in patients with rheumatologic disease and elevated atherosclerotic cardiovascular disease (ASCVD) risk.

We analyzed deidentified EPIC Cosmos records (277 million patients, 1,597 hospitals, 17 billion encounters) from 1/2020-1/2025. Adults with any of 11 rheumatologic conditions associated with elevated CV risk-including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, and systemic sclerosis-were included. We described prevalence of elevated ASCVD risk (=7.5%), prescription rates of antihyperlipidemic therapy and attainment of guideline directed LDL-C <70 mg/dL.

Among ≈4 million included patients, ASCVD-related comorbidities were common: diabetes (19.6%), hypertension (52.1%), dyslipidemia (51.4%). Mean LDL was 98 mg/dL; mean A1c was 7.1% in diabetics and 5.6% in nondiabetics. Only 18.1% achieved LDL <70 mg/dL during the study period. Despite 41.9% having a Cardiology and 36.4% a Rheumatology encounter, 22.7% of dyslipidemic patients were not on antihyperlipidemic therapy. Among those with ASCVD risk 7.5-20%, 28.5% were not on antihyperlipidemic therapy (17.0% with myalgias). For ASCVD risk >20%, 19.9% were not on antihyperlipidemic therapy (17.3% with myalgias).

In this large US cohort, lipid management and CV risk goal attainment were suboptimal across rheumatologic conditions. These findings underscore the need for multidisciplinary cardio-rheumatology care and implementation strategies to improve outcomes in this high-risk population.