Many patients with rheumatoid arthritis (RA) are not receiving appropriate management of cardiovascular risk factors, in particular, lipid testing and treatment of high cholesterol levels. A retrospective study found that patients with RA are less frequently screened and managed for hyperlipidemia compared with patients who have diabetes mellitus (DM).
“Cardiovascular disease is the number one killer of patients with RA. Even though inflammation is a major trigger of RA [and cardiovascular disease], and RA drugs attack inflammation, that shouldn’t preclude attention to cardiovascular risk factors,” said lead author Iris Navarro-Millán, MD, University of Alabama at Birmingham.
The study was initiated to compare the rates of lipid testing and management among patients with RA or DM and the general population.
Study participants (n = 379,949) were derived from databases of private and public health plans from 2006 to 2010. Eligible participants had to have at least 12 months of continuous medical and pharmacy coverage, and at least 2 physician diagnoses and relevant medications for RA and DM, either condition alone, or neither condition.
Participants were age 40 years or older with at least 2 years of follow-up from baseline. Those with a history of coronary heart disease or cardiovascular disease were excluded.
RA patients were less frequently tested for low-density lipoprotein cholesterol (LDL-C) than DM patients with or without RA, or patients who had neither condition. RA patients were less frequently treated with a statin at a threshold of ≥130 mg LDL-C compared with DM patients and RA patients with DM. Patients with RA received statins slightly more frequently than did patients with neither condition.
The frequency of LDL-C testing and treatment at 2 years of follow-up was compared as well. In patients with neither condition, 49% were screened and 9% were initiated on a statin. In the group with both RA and DM, 62% were screened and 28% initiated on a statin. Among the RA-only patients, 47% were screened and 13% were treated with a statin, and in the DM-only group, 64% were screened and 26% were treated with a statin.
“Further studies are needed to investigate the reasons and potential interventions to close this gap in care among RA patients,” Dr Navarro-Millán said.
Navarro-Millán I, Yang S, Safford M, et al. Frequency of lipid testing and management among rheumatoid arthritis patients compared to the general population and patients with diabetes. Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 131.