| Statin use in rheumatoid arthritis in relation to actual cardiovascular risk: evidence for substantial undertreatment of lipid-associated cardiovascular risk? | |
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MedLine Citation:
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PMID: 19854705 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 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% 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. |
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Authors:
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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 |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2009-10-23 |
Journal Detail:
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Title: Annals of the rheumatic diseases Volume: 69 ISSN: 1468-2060 ISO Abbreviation: Ann. Rheum. Dis. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-18 Completed Date: 2010-04-16 Revised Date: 2011-12-01 |
Medline Journal Info:
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Nlm Unique ID: 0372355 Medline TA: Ann Rheum Dis Country: England |
Other Details:
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Languages: eng Pagination: 683-8 Citation Subset: IM |
Affiliation:
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Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Distribution Age Factors Aged Algorithms Arthritis, Rheumatoid / complications* Cardiovascular Diseases / etiology, prevention & control* Dyslipidemias / drug therapy, etiology Epidemiologic Methods Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use* Male Middle Aged Patient Selection |
| Grant Support | |
ID/Acronym/Agency:
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17682//Arthritis Research UK; 18848//Arthritis Research UK; 18848//Arthritis Research UK |
| Chemical | |
Reg. No./Substance:
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0/Hydroxymethylglutaryl-CoA Reductase Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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