PARIS — The European League Against Rheumatism Task Force on Cardiovascular Risk Management in Rheumatoid Arthritis has recommended annual cardiovascular risk screening for all patients with rheumatoid arthritis.
The task force also advised annual screening be considered for patients with ankylosing spondylitis or psoriatic arthritis as well, said task force member Dr. Mike J.L. Peters, in an interview.
These recommendations, to be published by year's end, were announced at the annual European Congress of Rheumatology. Included will be guidance on employing a multiplier or conversion factor in conjunction with the Systematic Coronary Risk Evaluation (SCORE)—the European equivalent of the Framingham Risk Score—in order to more accurately reflect the increased cardiovascular risk of patients with inflammatory arthritis.
In a separate presentation, Dr. Peters reported on his own data showing that the increased cardiovascular risk of RA patients is similar in magnitude to that associated with type 2 diabetes. This supports arguments for aggressive risk factor management in the RA population, especially given that type 2 diabetes is considered a coronary heart disease equivalent, meaning that diabetic individuals have roughly the same risk of future cardiovascular events as patients who've already had an acute MI, according to Dr. Peters of VU University Medical Center, Amsterdam.
Dr. Peters reported on 353 normoglycemic patients with RA of an average 7 years' duration and varied severity, 194 type 2 diabetic patients, and 258 healthy controls. All were aged 50-75. The prevalence of objective cardio- and/or cerebrovascular disease was 21.6% in patients with type 2 diabetes, 15.7% in those with RA, and 9.7% in controls.
After adjustment for differences in age, gender, and rates of the traditional cardiovascular risk factors, the prevalence of cardiovascular disease was found to be 85% greater in diabetic patients than controls, and 51% greater in the RA group than controls. The rates in diabetic and RA patients were not significantly different.
Audience member Dr. Daniel H. Solomon urged a cautious interpretation of the Dutch findings.
“When we think about diabetes as a risk factor for cardiovascular disease, we understand that some of the management techniques—aspirin, statins, other preventive measures—have been tested specifically in diabetic populations. But at this point, we have almost no data on the benefits of these sorts of preventive measures in a rheumatoid population,” according to Dr. Solomon of Harvard Medical School, Boston.
“I'd be very careful about concluding that similar preventive measures would be beneficial in rheumatoids. We just don't have those data. I don't disagree that they might be, but I don't think we have enough data to make an evidence-based statement about that,” he said. Dr. Peters said he agreed.
In a separate presentation, Dr. Peters reported that the rate of major cardiovascular events in 329 Dutch RA patients followed prospectively for nearly 3 years was 8.6%, compared with 4.3% in 1,852 controls drawn from the general population.
The RA patients had higher rates of smoking, hypertension, and some other traditional cardiovascular risk factors, as has been reported in other studies. But after adjusting for age, gender, and traditional risk factors, the cardiovascular event rate in the RA population remained twofold greater than in the general population, according to Dr. Peters.