Cardiovascular Prevention Lacking in Rheumatoid Arthritis Save

An increased cardiovascular disease (CVD) risk in rheumatoid arthritis is well known and feared but an RA cohort study suggests that preventive medication use in RA patients lags behind that seen in diabetes mellitus (DM).

A multicenter, multinational cohort study (Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis) evaluated the prevalence of CVD in RA with (RA-DM) and without (RAwoDM) diabetes. The study population was divided into those with and without atherosclerotic cardiovascular disease (ASCVD). The objective was to study if risk factors for CVD would lead to primary and secondary prevention measures.

Among 10543 RA patients, 13% had DM and ASCVD was present in 27% of RA-DM vs. 11.6% RAwoDM (p<0.001).

When comparing RA-DM to RAwoDM, the former had more hypertension, hyperlipidemia, lipid-lowering or antihypertensive drug use than the latter (p<0.001 for all).

Most ASCVD patients did not reach their goal of an LDL cholesterol <1.8 mmol/L.  If diabetes was present (RA-DM) patients were more likely to have achieved their lower LDL goal than RAwoDM. No significant differences in HTN or BP management were seen between RA-DM and RAwoDM.

These data suggest that CVD prevention and lipid lowering medication use were more likely to be driven by diabetes than RA.  The authors concluded that, "CVD prevention programs in DM to clinically benefit patients with RA ".