Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic

Abstract

Objectives: To perform cardiovascular (CV) risk stratification in patients with inflammatory joint diseases (IJD) and treat to lipid targets according to recommendations.

Methods: We initiated a preventive cardio-rheuma clinic based on the unmet need of adequate CV prevention in IJD patients. A full CV risk stratification was performed at the first consultation (history of conventional risk factors and of CV disease, lipid measurement, blood pressure and ultrasound examination of both carotid arteries), and the patient was classified to either a primary or secondary CV prevention regime, or to have low risk (no intervention). Lipid lowering (LL) treatment was adjusted until at least two lipid targets were achieved.

Results: Of the 426 patients referred, 36.6% had a systematic coronary risk evaluation (SCORE) <5% (no LL intervention). The remaining 270 patients [(rheumatoid arthritis (RA): n=165, ankylosing spondylitis (AS): n=70, and psoriatic arthritis (PsA): n=35] were categorized to either primary (n=63) or secondary prevention (n=207). There were significant differences between the patient groups regarding age (p<0.001), sex (p<0.001) and disease duration (p<0.001). Lipid changes in IJD patients were; total cholesterol: 1.86±1.20 mmol/L (p<0.001), low density lipoprotein cholesterol: 1.74±1.11 (p<0.001), high density lipoprotein cholesterol: -0.01±0.30 (p=0.61), triglycerides: 0.28±0.72 (p<0.001). The proportions of patients reaching at least 2 lipid targets were for RA/AS/PsA: 92.1/90.0/82.9% respectively. No serious adverse events were observed.

Conclusions: There was indication for CV prevention in a high proportion of IJD patients referred for CV risk stratification. Treatment to lipid targets was successful in approximately 90% of patients with IJD.