RESEARCH - Statin use in RA in relation to actual cardiovascular risk

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Ann Rheum Dis. Published Online First: 23 October 2009.

doi:10.1136/ard.2009.115717

Statin use in rheumatoid arthritis in relation to actual

cardiovascular risk: evidence for substantial under treatment of lipid

associated cardiovascular risk?

Tracey E Toms1,*, Vasileios F Panoulas1, M J 1, Helen

Griffiths2, Naveed Sattar3, P 1, Deborah P.M Symmons4,

Nightingale5, S Metsios1, D Kitas1

1 Dudley Group of Hospitals NHS Foundation Trust, United Kingdom;

2 Life and Health Sciences, Aston University, Birmingham, United Kingdom;

3 Univesity of Glasgow, Glasgow, Scotland, United Kingdom;

4 arc Epidemiology Unit, Manchester University, Manchester, United Kingdom;

5 Wolfson Computer Laboratory, University Hospital Birmingham NHS

Foundation Trust, Birmingham, United Kingdom

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 RA patients requiring statin

therapy identified by conventional risk calculators, and ( 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 RA patients, by applying risk calculators with or

without a x1.5 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%-94.8%) not receiving

statins. The application of a 1.5 multiplier identified 17%-78% more

at risk patients.

Conclusions: Depending on the risk stratification method, 2%-26% of RA

patients 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.

http://ard.bmj.com/cgi/content/abstract/ard.2009.115717v1?papetoc

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