229: Management of dyslipidemia in patients with early rheumatism arthritis. Results of ESPOIR cohort

Abstract

Cardiovascular (CV) disease accounts for about half of all deaths in rheumatoid arthritis (RA). This excess risk is driven in part by inflammation but may be reduced by management of traditional risk factors. EULAR recommends a multiplier of 1.5, applied to a conventional CV risk assessment (SCORE or Framingham equation), for patients with RA with 2 of the following 3 criteria: disease duration >10 years, rheumatoid factor (RF) or ACPA positivity and presence of severe extra-articular manifestation. Crowson suggests multiplying when only one criterion is fulfilled. New targets for LDL-cholesterol have been defined with SCORE equation. A new FRS (Framingham global risk score) has been developed for a composite of all cerebrovascular events. According to guidelines, the aim of our study was to determine in an early RA cohort during 4-year follow-up, the proportion of patients in whom the LDL-Cholesterol level was not reached. We followed 186 patients with RA from the French ESPOIR cohort from 2003 to 2007. At inclusion, the mean age was 53.45, and 77.42% were women. Respectively 90 and 103 patients had RF and ACPA positivity and 11 had extra articular manifestations. Eight had diabetes mellitus and 90 were smokers. Statins were prescribed in 14 (7.5%) patients and 37 received antihypertensive drugs. The percentage of patients identified with dyslipidemia ranged significantly depending on the method (cf. table). The rate of patients who needed to be treated by statins varied from 7 to 25.8% at inclusion and from 22.7 to 32.8% at 4 years. By considering RA as an independent risk factor or applying a 1.5 multiplying factor, this rate varied from 18.8 to 26.9% at inclusion and from 22.7 to 43% at 4 years. The application of a 1.5 multiplier identified more patients especially when only one factor was taken into account. Although rheumatologists are increasingly aware of the increase in cardiovascular risk, there was no improvement in management of lipid disorders over time. Table – Prevalence of dyslipidemia depends on guidelines. Baseline N=186 (%) Year 1 N=153 (%) Year 2 N=141 (%) Year 3 N=137 (%) Year 4 N=128 (%) SCORE 25 (13.4) 20 (13.1) 23 (16.3) 25 (18.2) 28 (21.9) SCORE × 1,5 (2 conditions) 26 (14) 20 (13.1) 23 (16.3) 25 (18.2) 28 (21.9) SCORE × 1,5 (1 condition) 49 (26.3) 54 (35.3) 49 (34.7) 60 (43.8) 59 (46.1) NCEP (FRS) 51 (27.4) 41 (26.8) 30 (21.3) 32 (23.4) 44 (34.4) NCEP × 1,5 (2 conditions) 51 (27.4) 42 (27.4) 30 (21.3) 32 (23.4) 44 (34.4) NCEP × 1,5 (1 condition) 54 (29) 44 (28.7) 31 (22) 32 (23.4) 45 (35.2) AFSSAPS (FRS global) 21 (11.3) 14 (9.2) 11 (7.8) 14 (10.2) 22 (17.2) AFSSAPS (FRS global)×1,5 (2 conditions) 22 (11.8) 15 (9.8) 11 (7.8) 14 (10.2) 22 (17.2) AFSSAPS (FRS global) × 1,5 (1 condition) 33 (17.7) 27 (17.6) 22 (15.6) 23 (16.8) 30 (23.4)