Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD), including peripheral vascular disease, stroke, myocardial infarction, and heart failure compared to the general population1,2. The absolute CV risk is estimated to be up to 2-fold increased1,2. The risk is increased because of chronic, systemic inflammation, as well as premature atherosclerosis. In addition to the risk inherent to the underlying disease, conventional risk factors are major contributors to the increase in recurrence of CVD, including dyslipidemia, hypertension (HTN), obesity, smoking, and diabetes3.
In this edition of The Journal, Barber, et al report on the experience of using CV risk indicators in clinical practice4. In 2 cohorts of patients, 1 in which patients enrolled into an early RA disease clinic and the other where patients enrolled into a biologic registry, the authors report on the frequencies with which CVD indicators are assessed. These are summarized in a baseline 10-year Framingham Risk Score for those patients whose risk is identified by the Framingham Risk Score, age 30–74 years, and not taking a baseline statin. As anticipated, patients in the biologics cohort generally had more active disease, had worse functional status, were more likely to have erosive disease, and had extraarticular disease.
The quality indicators assessed as CVD risk factors in the study included evidence of discussion of increased CV risk with the patient, formal CV risk assessment, assessment of smoking status and offer of smoking cessation counseling, screening for HTN and communication of HTN findings to the patient’s primary care provider, measurement of lipid profile, screening for diabetes, exercise counseling, and body mass index screening and lifestyle counseling, as well as documented attempts to reduce glucocorticoid usage and communication of the …
Address correspondence to Dr. E.L. Matteson, Mayo Clinic and Mayo Foundation, 200 1st St., South West, Rochester, Minnesota 55905, USA; E-mail: matteson.eric{at}mayo.edu