Management of Traditional Modifiable Cardiovascular Risk Factors including Hyperlipidemia, Hypertension, Diabetes Mellitus and Smoking among Rheumatoid Arthritis patients in the Midwest region of Ireland
Maria Usman Khan1, 2, Fahd Adeeb1, 2, Usman Azhar Khan2,3, Joseph Devlin1, Alexander Fraser1, 2
1. Rheumatology Department, University Hospital Limerick 2. Graduate Entry Medical School, University of Limerick 3. Cardiology Department, University Hospital Limerick
Rheumatoid Arthritis (RA) is known to be associated with a substantially increased risk of cardiovascular disease (CVD). Although inflammation has been shown to be a key component in the development of CVD in RA patients1, there is also a high prevalence of traditional modifiable CVD risk factors in this group. Recording of these risk factors is a cornerstone in CVD risk management in RA patients.
The aim of this study is to evaluate the existing cardiovascular risk reduction practice in patients with RA by assessing the efficiency of recording and management of traditional modifiable cardiovascular risk factors including hyperlipidemia, hypertension, diabetes mellitus and smoking.
This multicenter retrospective cross-sectional study involved 2 teaching hospitals (Croom hospital & University Hospital Limerick). 100 consecutive patients with definite RA were recruited between May and June 2016. A proforma was completed for each patient based on medical notes and electronic record data.
1. 87 patients (87%) had their full lipid profile screening in last four years. 43 patients had adequate data (age, gender, smoking, blood pressure and lipid profile) to calculate the 10-year risk of fatal CVD based on SCORE model. 17/43 patients (39.53%) were candidates for de novo statin therapy and lipid control was suboptimal in 6/43 patients (13.95%) on existing statin therapy.
2. Blood pressure (BP) record was available in 66 patient (66%). 10 out of 22 patients (45.45%) in BP range ≥ 140/90 mmHg were already on anti-hypertensive treatment, representing suboptimal control while another 12 patients (54.54%) in the same BP record category were potential candidate for de-novo anti-hypertensive therapy.
3. 6 patients (6%) were found diabetic in medical notes. 5 out of 6 diabetic patients (83.33%) had recent HbA1c (< 1-year), which demonstrated suboptimal diabetic control (HbA1c > 7%) in 3 patients (60%).
4. 66 patients (66%) had their smoking status documented and 25 (37.87%) of them were active smoker. None of the patients had documentation of smoking cessation advice in their medical notes.
Traditional cardiovascular risk factors including hyperlipidemia, hypertension, diabetes mellitus and smoking are highly prevalent, under-diagnosed, and poorly controlled in patients with RA, despite appreciation that these conditions are associated with an increased burden of cardiovascular disease. The implementation of effective recording and management of these traditional modifiable risk factors in daily clinical rheumatological practice is an important first step in the process of augmenting the prevention of CVD in RA patients.