Cardiovascular Risk in RA Patients: FallingBetween the Cracks?
February 8, 2013Desai SS, Myles JM, and MJ Kaplan. Suboptimal cardiovascular risk factor identification and management in , (2012)14:R270patients with rheumatoid arthritis: a cohort analysis.
Arthritis Research & Therapy
doi:10.1186/ar4118.Rheumatologists may be well aware of the increased risk for cardiovascular disease (CVD) among patientswith rheumatoid arthritis (RA), but a recent study suggests that they may be focusing on the rheumaticproblem while passing the cardiovascular one to primary care providers (PCPs), who too often are failing topick up the ball.According to a retrospective cohort study conducted among patients at the University of Michigan, PCPswere significantly better than rheumatologists at identifying and managing obesity, high blood pressure, andelevated lipids in RA patients. But even they had more success among patients with diabetes, whose risk level is similar, than among RA patients.The researchers compared records of patients at a tertiary care center who were matched for age, gender andethnicity and divided into three groups of 251 subjects each: patients with RA, those with diabetes mellitus,and people without either disease who were being seen for other problems. Most of the patients wereCaucasian women; the mean age was 49. Researchers reviewed electronic patient records from a continuous12-month period (June 2007 through April 2011) to see how well rheumatologists and PCPs managed CVDrisk factors.In overweight and obese patients, a subgroup analysis found that PCPs managed weight in 31% of those withRA, 68% of those with diabetes, and 46% of unaffected patients. PCPs also identified and managed smokingstatus, lipid levels and fasting blood glucose more frequently in RA patients than did rheumatologists. Rheumatologists identified elevated BMI in 27% of patients with RA and helped only 6% to achieve weightreductions. They identified smoking status in only 21% and managed it in 13%. The rheumatologists didsomewhat better at identifying high blood pressure, which they reported correctly in 93% of the hypertensiveRA patients. But they achieved the necessary reductions in only 6%. They identified elevated lipids in just6% of affected RA patients and resolved the problem in only 2%..The authors speculate that many rheumatologists overlook cardiovascular issues in their RA patients,assuming (correctly or otherwise) that the PCP is taking care of that. But according to these findings RApatients do not benefit from the same vigilance for CVD risk factors in primary care that is offered forpatients who have diabetes.Better coordination of care is needed, the authors suggest, and perhaps more aggressive management of cardiovascular risk by the doctors who see RA patients most often.
Vol. No. February 8, 2013