Rheumatoid Arthritis, Statin Indication and Lipid Goals: Analysis According to Different Recommendations

Walter Masson; Emiliano Rossi; Rodolfo N Alvarado; Guillermo Cornejo-Peña; Juan I Damonte; Norberto Fiorini; Lorena M Mora-Crespo; Mayra A Tobar-Jaramillo; Marina Scolnik

doi:10.1016/j.reuma.2021.02.002

Rheumatoid Arthritis, Statin Indication and Lipid Goals: Analysis According to Different Recommendations

Reumatol Clin (Engl Ed). 2021 Mar 18:S1699-258X(21)00056-5. doi: 10.1016/j.reuma.2021.02.002. Online ahead of print.

[Article in English, Spanish]

Authors

Walter Masson¹, Emiliano Rossi², Rodolfo N Alvarado³, Guillermo Cornejo-Peña², Juan I Damonte², Norberto Fiorini², Lorena M Mora-Crespo², Mayra A Tobar-Jaramillo³, Marina Scolnik³

Affiliations

¹ Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: walter.masson@hospitalitaliano.org.ar.
² Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina.
³ Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina.

PMID: 33745866
DOI: 10.1016/j.reuma.2021.02.002

Abstract

Background: Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA).

Objectives: (1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals.

Methods: A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor×1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed.

Results: A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals.

Conclusion: Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals.

Keywords: Artritis reumatoide; Estatinas; Estratificación de riesgo; LDL-C goals; Objetivos de C-LDL; Puntuaciones de riesgo; Rheumatoid arthritis; Risk scores; Risk stratification; Statins.