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Canadian Journal of Cardiology

Statin Use for Primary Cardiovascular Disease Prevention Is Low in Inflammatory Arthritis

Published:April 13, 2022DOI:https://doi.org/10.1016/j.cjca.2022.04.002

      Abstract

      Background

      Patients with inflammatory arthritis (IA) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet management of dyslipidemia is infrequently prioritized. We applied Canadian dyslipidemia guidelines to determine how many patients with IA would be eligible for primary prevention with statins.

      Methods

      We conducted a cross-sectional study of patients with IA in a cardio-rheumatology clinic, with no known CVD and without statin therapy at cohort entry. We stratified patients by Framingham Risk Score (FRS) and summarized the proportion meeting guideline statin-indicated criteria. Multivariable logistic regression analyses determined the association of variables with statin indication after adjustment for age, sex, traditional ASCVD risk factors, and arthritis characteristics.

      Results

      Among 302 patients, most had rheumatoid arthritis (59%). Mean age was 58 years, and 71% were female. Overall, 50% of the cohort was eligible for statin therapy. The majority was low FRS risk category (68%), and the most frequent qualifier for statins was elevated apolipoprotein B (ApoB) levels or low-density lipoprotein cholesterol (LDL-c) levels. In the intermediate FRS group, 91% met criteria for statin therapy based on the presence of a coronary artery calcification (CAC) score > 0 or an elevated high-sensitivity C-reactive protein. Male sex, hypertension, elevated ApoB, and a CAC score > 0 were the factors most strongly associated with indication for statin therapy.

      Conclusions

      Statin therapy is suboptimal in IA despite a significant number of patients meeting indication based on lipoprotein thresholds or CAC scores. Understanding the barriers and potential facilitators of implementing and interpreting these CVD screening tools in IA is needed.

      Résumé

      Contexte

      Il existe chez les patients atteints d’arthrite inflammatoire (AI) un risque élevé de maladie cardiovasculaire athéroscléreuse (MCVAS). Néanmoins, la prise en charge de la dyslipidémie est rarement prioritaire. Nous avons appliqué les lignes directrices canadiennes sur la dyslipidémie pour déterminer le nombre de patients atteints d’AI qui seraient admissibles à une prévention primaire par des statines.

      Méthodologie

      Nous avons mené une étude transversale regroupant des patients atteints d’AI suivis dans une clinique de cardiorhumatologie. Les patients n’étaient atteints d’aucune MCV avérée et ne suivait aucun traitement par des statines au moment de leur inclusion dans la cohorte. Nous avons stratifié les patients selon le score de risque de Framingham (SRF) et établi la proportion de patients répondant aux critères d’indication des statines selon les lignes directrices. Des analyses de régression logistique multivariées ont permis de déterminer l’association entre les variables et l’indication des statines après ajustement en fonction de l’âge, du sexe, des facteurs de risque de MCVAS classiques et des caractéristiques de l’arthrite.

      Résultats

      La plupart (59 %) des 302 patients que comptait la cohorte présentaient une polyarthrite rhumatoïde. L’âge moyen était de 58 ans et 71 % des patients étaient des femmes. Dans l’ensemble, 50 % de la cohorte était admissible au traitement par des statines. Le SRF plaçait la majorité des patients (68 %) dans la catégorie à faible risque, et le critère d’indication des statines le plus fréquent était un taux élevé d’apolipoprotéine B (apo B) ou de cholestérol à lipoprotéines de faible densité (cLDL). Dans la catégorie à risque modéré selon le SRF, 91 % des patients répondaient aux critères de traitement par des statines du fait qu’ils avaient obtenu un score de calcification des artères coronaires (CAC) > 0 ou présentaient un taux élevé de protéine C-réactive à haute sensibilité. Le sexe masculin, l’hypertension, un taux élevé d’apo B et un score CAC > 0 étaient les facteurs les plus fortement associés à l’indication du traitement par des statines.

      Conclusions

      Le traitement par des statines est sous-optimal en cas d’AI, même si un nombre significatif de patients répondent aux critères d’indication fondés sur les seuils de lipoprotéines ou les scores de CAC. Il est nécessaire de comprendre ce qui peut limiter la mise en œuvre et l’interprétation de ces outils de dépistage des maladies cardiovasculaires chez les patients atteints d’AI, et éventuellement faciliter leur utilisation.
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      Linked Article

      • Preventing Cardiovascular Events in Patients With Inflammatory Arthritis: Are We Missing the Mark?
        Canadian Journal of CardiologyVol. 38Issue 8
        • Preview
          Inflammation promotes atherogenesis at several points in the evolution of the disease process.1 Consequently, individuals with chronic inflammation, such as those living with inflammatory arthritis—including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis—have an increased lifetime risk of developing atherosclerotic cardiovascular disease (ASCVD).1,2 This susceptibility is independent of traditional modifiable risk factors1,2 including atherogenic lipoproteins, whose levels are variable in inflammatory arthritis patients and are influenced by anti-inflammatory therapies.
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