Statin use in rheumatoid arthritis in relation to actual cardiovascular risk

evidence for substantial undertreatment of lipid-associated cardiovascular risk?

Tracey E. Toms, Vasileios F. Panoulas, Karen M.J. Douglas, Helen Griffiths, Naveed Sattar, Jaqueline P. Smith, Deborah P.M. Symmons, Peter Nightingale, George S. Metsios, George D. Kitas

Research output: Contribution to journalArticle

Abstract

Background Cardiovascular disease (CVD) is partially attributed to traditional cardiovascular risk factors, which can be identified and managed based on risk stratification algorithms (Framingham Risk Score, National Cholesterol Education Program, Systematic Cardiovascular Risk Evaluation and Reynolds Risk Score). We aimed to (a) identify the proportion of at risk patients with rheumatoid arthritis (RA) requiring statin therapy identified by conventional risk calculators, and (b) assess whether patients at risk were receiving statins.

Methods Patients at high CVD risk (excluding patients with established CVD or diabetes) were identified from a cohort of 400 well characterised patients with RA, by applying risk calculators with or without a ×1.5 multiplier in specific patient subgroups. Actual statin use versus numbers eligible for statins was also calculated.

Results The percentage of patients identified as being at risk ranged significantly depending on the method, from 1.6% (for 20% threshold global CVD risk) to 15.5% (for CVD and cerebrovascular morbidity and mortality) to 21.8% (for 10% global CVD risk) and 25.9% (for 5% CVD mortality), with the majority of them (58.1% to 94.8%) not receiving statins. The application of a 1.5 multiplier identified 17% to 78% more at risk patients.

Conclusions Depending on the risk stratification method, 2% to 26% of patients with RA without CVD have sufficiently high risk to require statin therapy, yet most of them remain untreated. To address this issue, we would recommend annual systematic screening using the nationally applicable risk calculator, combined with regular audit of whether treatment targets have been achieved.
Original languageEnglish
Pages (from-to)683-688
Number of pages6
JournalAnnals of the Rheumatic Diseases
Volume69
Issue number4
Early online date23 Oct 2009
DOIs
Publication statusPublished - Apr 2010

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Rheumatoid Arthritis
Lipids
Cardiovascular Diseases
Mortality

Keywords

  • age distribution
  • age factors
  • aged
  • algorithms
  • rheumatoid arthritis
  • cardiovascular diseases
  • dyslipidemias
  • epidemiologic methods
  • female
  • humans
  • hydroxymethylglutaryl-CoA Reductase Inhibitors
  • male
  • middle aged
  • patient selection

Cite this

Toms, Tracey E. ; Panoulas, Vasileios F. ; Douglas, Karen M.J. ; Griffiths, Helen ; Sattar, Naveed ; Smith, Jaqueline P. ; Symmons, Deborah P.M. ; Nightingale, Peter ; Metsios, George S. ; Kitas, George D. / Statin use in rheumatoid arthritis in relation to actual cardiovascular risk : evidence for substantial undertreatment of lipid-associated cardiovascular risk?. In: Annals of the Rheumatic Diseases. 2010 ; Vol. 69, No. 4. pp. 683-688.
@article{15fae512b26c4ce38676bb73453c4f1c,
title = "Statin use in rheumatoid arthritis in relation to actual cardiovascular risk: evidence for substantial undertreatment of lipid-associated cardiovascular risk?",
abstract = "Background Cardiovascular disease (CVD) is partially attributed to traditional cardiovascular risk factors, which can be identified and managed based on risk stratification algorithms (Framingham Risk Score, National Cholesterol Education Program, Systematic Cardiovascular Risk Evaluation and Reynolds Risk Score). We aimed to (a) identify the proportion of at risk patients with rheumatoid arthritis (RA) requiring statin therapy identified by conventional risk calculators, and (b) assess whether patients at risk were receiving statins. Methods Patients at high CVD risk (excluding patients with established CVD or diabetes) were identified from a cohort of 400 well characterised patients with RA, by applying risk calculators with or without a ×1.5 multiplier in specific patient subgroups. Actual statin use versus numbers eligible for statins was also calculated. Results The percentage of patients identified as being at risk ranged significantly depending on the method, from 1.6{\%} (for 20{\%} threshold global CVD risk) to 15.5{\%} (for CVD and cerebrovascular morbidity and mortality) to 21.8{\%} (for 10{\%} global CVD risk) and 25.9{\%} (for 5{\%} CVD mortality), with the majority of them (58.1{\%} to 94.8{\%}) not receiving statins. The application of a 1.5 multiplier identified 17{\%} to 78{\%} more at risk patients. Conclusions Depending on the risk stratification method, 2{\%} to 26{\%} of patients with RA without CVD have sufficiently high risk to require statin therapy, yet most of them remain untreated. To address this issue, we would recommend annual systematic screening using the nationally applicable risk calculator, combined with regular audit of whether treatment targets have been achieved.",
keywords = "age distribution, age factors, aged, algorithms, rheumatoid arthritis, cardiovascular diseases, dyslipidemias, epidemiologic methods, female, humans, hydroxymethylglutaryl-CoA Reductase Inhibitors, male, middle aged, patient selection",
author = "Toms, {Tracey E.} and Panoulas, {Vasileios F.} and Douglas, {Karen M.J.} and Helen Griffiths and Naveed Sattar and Smith, {Jaqueline P.} and Symmons, {Deborah P.M.} and Peter Nightingale and Metsios, {George S.} and Kitas, {George D.}",
year = "2010",
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doi = "10.1136/ard.2009.115717",
language = "English",
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Toms, TE, Panoulas, VF, Douglas, KMJ, Griffiths, H, Sattar, N, Smith, JP, Symmons, DPM, Nightingale, P, Metsios, GS & Kitas, GD 2010, 'Statin use in rheumatoid arthritis in relation to actual cardiovascular risk: evidence for substantial undertreatment of lipid-associated cardiovascular risk?', Annals of the Rheumatic Diseases, vol. 69, no. 4, pp. 683-688. https://doi.org/10.1136/ard.2009.115717

Statin use in rheumatoid arthritis in relation to actual cardiovascular risk : evidence for substantial undertreatment of lipid-associated cardiovascular risk? / Toms, Tracey E.; Panoulas, Vasileios F.; Douglas, Karen M.J.; Griffiths, Helen; Sattar, Naveed; Smith, Jaqueline P.; Symmons, Deborah P.M.; Nightingale, Peter; Metsios, George S.; Kitas, George D.

In: Annals of the Rheumatic Diseases, Vol. 69, No. 4, 04.2010, p. 683-688.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Statin use in rheumatoid arthritis in relation to actual cardiovascular risk

T2 - evidence for substantial undertreatment of lipid-associated cardiovascular risk?

AU - Toms, Tracey E.

AU - Panoulas, Vasileios F.

AU - Douglas, Karen M.J.

AU - Griffiths, Helen

AU - Sattar, Naveed

AU - Smith, Jaqueline P.

AU - Symmons, Deborah P.M.

AU - Nightingale, Peter

AU - Metsios, George S.

AU - Kitas, George D.

PY - 2010/4

Y1 - 2010/4

N2 - Background Cardiovascular disease (CVD) is partially attributed to traditional cardiovascular risk factors, which can be identified and managed based on risk stratification algorithms (Framingham Risk Score, National Cholesterol Education Program, Systematic Cardiovascular Risk Evaluation and Reynolds Risk Score). We aimed to (a) identify the proportion of at risk patients with rheumatoid arthritis (RA) requiring statin therapy identified by conventional risk calculators, and (b) assess whether patients at risk were receiving statins. Methods Patients at high CVD risk (excluding patients with established CVD or diabetes) were identified from a cohort of 400 well characterised patients with RA, by applying risk calculators with or without a ×1.5 multiplier in specific patient subgroups. Actual statin use versus numbers eligible for statins was also calculated. Results The percentage of patients identified as being at risk ranged significantly depending on the method, from 1.6% (for 20% threshold global CVD risk) to 15.5% (for CVD and cerebrovascular morbidity and mortality) to 21.8% (for 10% global CVD risk) and 25.9% (for 5% CVD mortality), with the majority of them (58.1% to 94.8%) not receiving statins. The application of a 1.5 multiplier identified 17% to 78% more at risk patients. Conclusions Depending on the risk stratification method, 2% to 26% of patients with RA without CVD have sufficiently high risk to require statin therapy, yet most of them remain untreated. To address this issue, we would recommend annual systematic screening using the nationally applicable risk calculator, combined with regular audit of whether treatment targets have been achieved.

AB - Background Cardiovascular disease (CVD) is partially attributed to traditional cardiovascular risk factors, which can be identified and managed based on risk stratification algorithms (Framingham Risk Score, National Cholesterol Education Program, Systematic Cardiovascular Risk Evaluation and Reynolds Risk Score). We aimed to (a) identify the proportion of at risk patients with rheumatoid arthritis (RA) requiring statin therapy identified by conventional risk calculators, and (b) assess whether patients at risk were receiving statins. Methods Patients at high CVD risk (excluding patients with established CVD or diabetes) were identified from a cohort of 400 well characterised patients with RA, by applying risk calculators with or without a ×1.5 multiplier in specific patient subgroups. Actual statin use versus numbers eligible for statins was also calculated. Results The percentage of patients identified as being at risk ranged significantly depending on the method, from 1.6% (for 20% threshold global CVD risk) to 15.5% (for CVD and cerebrovascular morbidity and mortality) to 21.8% (for 10% global CVD risk) and 25.9% (for 5% CVD mortality), with the majority of them (58.1% to 94.8%) not receiving statins. The application of a 1.5 multiplier identified 17% to 78% more at risk patients. Conclusions Depending on the risk stratification method, 2% to 26% of patients with RA without CVD have sufficiently high risk to require statin therapy, yet most of them remain untreated. To address this issue, we would recommend annual systematic screening using the nationally applicable risk calculator, combined with regular audit of whether treatment targets have been achieved.

KW - age distribution

KW - age factors

KW - aged

KW - algorithms

KW - rheumatoid arthritis

KW - cardiovascular diseases

KW - dyslipidemias

KW - epidemiologic methods

KW - female

KW - humans

KW - hydroxymethylglutaryl-CoA Reductase Inhibitors

KW - male

KW - middle aged

KW - patient selection

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U2 - 10.1136/ard.2009.115717

DO - 10.1136/ard.2009.115717

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EP - 688

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

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