Recommendations For Cardiovascular Risk Management Research Articles

Chronic kidney disease: the missing concept in the 2019 EULAR/ERA-EDTA recommendations for lupus nephritis.

Chronic kidney disease (CKD) is diagnosed when glomerular filtration rate (GFR) falls below 60ml/min/1.73m2 or urinary albumin:creatinine ratio (UACR) reaches ≥30mg/g, as these two thresholds indicate a higher risk of adverse health outcomes, including cardiovascular mortality. CKD is classified as mild, moderate or severe, based on GFR and UACR values, and the latter two classifications convey a high or very high cardiovascular risk, respectively. Additionally, CKD can be diagnosed based on abnormalities detected by histology or imaging. Lupus nephritis (LN) is a cause of CKD. Despite the high cardiovascular mortality of patients with LN, neither albuminuria nor CKD are discussed in the 2019 European League Against Rheumatism (EULAR)/European Renal Association-European Dialysis and Transplant Association recommendations for the management of LN or the more recent 2022 EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases. Indeed, the proteinuria target values discussed in the recommendations may be present in patients with severe CKD and a very high cardiovascular risk who may benefit from guidance detailed in the 2021 European Society of Cardiology guidelines on cardiovascular disease prevention in clinical practice. We propose that the recommendations should move from a conceptual framework of LN as an entity separate from CKD to a framework in which LN is considered a cause of CKD and evidence generated from large CKD trials applies unless demonstrated otherwise.

The impact of traditional cardiovascular risk factor control on 7-year follow-up atherosclerosis progression in systemic lupus erythematosus.

The 2022 EULAR recommendations for cardiovascular risk management in patients with rheumatic disorders, including SLE, call for rigorous management of cardiovascular risk factors (CVRF). The impact of CVRF target attainment on atherosclerotic plaque progression hasn't been previously evaluated in prospective ultrasound studies. A total of 115 patients with SLE and 1:1 age and sex-matched healthy controls who had a baseline carotid and femoral ultrasound examination in our cardiovascular research unit were invited for a 7-year follow-up assessment of new plaque development. We aimed to compare the incidence of plaque progression between SLE patients and controls and reveal the extent to which it is affected by the attainment of European Society of Cardiology (ESC) targets for modifiable CVRFs (blood pressure, smoking status, body weight, lipids and physical activity), and disease-related features (disease duration, disease activity, autoantibodies, treatments). Eighty-six SLE patients and 42 controls had a 7-year follow-up carotid and femoral plaque examination. New plaque development was observed in 32/86 patients vs 8/42 controls (P = 0.037). Patients with SLE had a 4-fold higher risk for plaque progression than controls (OR: 4.16, CI: 1.22, 14.19, P = 0.023), adjusting for potential confounders. Multivariate regression analyses showed a 50% decrease in plaque progression for every modifiable CVRF fulfilling ESC targets (OR: 0.56, CI: 0.34, 0.93, P = 0.026). Patients with SLE develop a rapid progression of atherosclerotic plaques which may be drastically reduced by CVRF target attainment according to ESC guidelines.

Everolimus in kidney transplant recipients at high cardiovascular risk: a narrative review.

Kidney transplant recipients (KTRs) are at increased risk of cardiovascular (CV) morbidity and mortality, and side effects induced by immunosuppressive therapy may be a major contributor to this risk, together with traditional CV risk factors. Many strategies have been considered in order to reduce CV risk in KTRs, such as steroid and/or calcineurin inhibitor (CNI) minimization, but current data are inconclusive. The introduction of mammalian target of rapamycin (mTOR) inhibitors, the cornerstone of CNI minimization, in the immunosuppressive protocol may reduce both the incidence and severity of CNI-associated side effects; however, whether this strategy has an impact on CV risk after kidney transplantation needs to be evaluated. To this end, a panel of Italian experts in the field of transplantation was convened in a series of meetings to assess the current literature on the potential of the mTOR inhibitor everolimus as a cardioprotective agent. This narrative review summarizes the panel's round-table discussions and provides recommendations for CV risk management in KTRs.

O119. Cardiovascular risk management after reproductive and pregnancy related disorders: A Dutch multidisciplinary evidence-based guideline

Introduction In the past decades evidence has accumulated that women with reproductive and pregnancy related disorders are at increased risk of developing cardiovascular disease (CVD) in the future. Up to now there is no standardized follow-up of these women since guidelines on cardiovascular risk management for this group are lacking. However, early identification of high-risk populations followed by prevention and treatment of CVD risk factors has the potential to reduce CVD incidence. Objective The Dutch Society of Obstetrics and Gynaecology initiated a multidisciplinary working group (gynecologists, cardiologist, vascular internist, radiologist, general practitioner, epidemiologist and representatives of patient associations) to develop a guideline for cardiovascular risk management after reproductive and pregnancy related disorders. Methods The guideline was developed using the “Appraisal of Guidelines for Research and Evaluation” instrument. The guideline addresses the cardiovascular risk consequences of gestational hypertension, preeclampsia, preterm delivery, small-for-gestational-age infant, recurrent miscarriage, polycystic ovary syndrome and premature ovarian insufficiency. The best available evidence on these topics was gathered by systematic review and the relation between the reproductive or pregnancy related disorders and CVD risk and risk factors was assessed by meta-analysis. Recommendations for clinical practice were formulated based on the number and quality of the studies and presence or absence of a relative risk > 2 of developing CVD events and/or risk factors from the meta-analysis. The Dutch societies of gynaecologists, cardiologists, vascular internists, radiologists, and general practitioners endorsed the guideline to ensure support for implementation in clinical practice. Results For all reproductive and pregnancy related disorders only a moderate increased relative risk ( 2) was found for overall CVD, except for preeclampsia (relative risk 2.15, 95% CI 1.76–2.61). Based on the current available evidence, follow-up is only recommended for women with a history of preeclampsia. A cardiovascular risk profile should be offered at the age of 50 years. Assessment of CVD risk and treatment of cardiovascular risk factors should be performed according to the Dutch guideline for cardiovascular risk management. For all reproductive and pregnancy related disorders optimization of modifiable cardiovascular risk factors is recommended to reduce the risk of future CVD. Conclusion In this guideline we present the recommendations for cardiovascular risk management after reproductive and pregnancy related disorders. To the best of our knowledge we are the first to make such recommendations in a national guideline.

AB0328 Gender Differences in Risk Factors for Cardiovascular Disease in Outpatients with Rheumatoid Arthritis

BackgroundPeople with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) [1,2]. Although male gender is generally associated with a greater risk for cardiovascular related mortality and death,...

THU0436 Screening for Cardiovascular Risk According to Eular 2010 Recommendations in Outpatients with Psoriasis Arthritis or Ankylosing Spondylitis

BackgroundEULAR 2010 recommendations advised attention on cardiovascular (CV) risk management in patients with psoriasis arthritis (PsA) or ankylosing spondylitis (AS) because of increased CV mortality [1].ObjectivesTo investigate the distribution of...

SP0166 How to Implement Systematic Cardio-Vascular Risk Assessment in Outpatients with Inflammatory Arthritis in Nursing Consultations in Accordance with the Eular Recommendations – A Danish Example

It is well known that patients' with inflammatory arthritis (IA) have an increased risk for cardiovascular (CV) morbidity and mortality based on both the inflammatory process and the increased prevalence...

OP0293 Implementation of the Eular Recommendations for Cardiovascular Risk Management in Germany: Results of A Cross-Sectional Epidemiologic Study

BackgroundThe increased cardiovascular (CV) risk of patients suffering from rheumatoid arthritis (RA) is well documented and can partially be explained by traditional risk factors [1]. Available evidence supports inflammatory arthritis...

THU0250 Cardiovascular risk assessment in systemic sclerosis using the score chart and reclassification by presence of plaques on ultrasonography

BackgroundIncreased cardiovascular (CV) risk and atherosclerosis have been described in patients with rheumatic diseases including systemic sclerosis (SSc). Besides traditional CV risk factors, endothelial dysfunction, and disease-specific factors, such as...

AB0406 Cardiovascular risk in rheumatoid arthritis: Are we aware?

Backgroundpatients with rheumatoid arthritis (RA) have a higher cardiovascular (CV) morbidity and mortality from accelerated atherosclerosis than the general population. The increased risk appears because of an increased prevalence of...

THU0556 Aerobic Exercise Training Improves Cardiovascular Risk in Patients with Rheumatoid Arthritis

BackgroundRheumatoid arthritis (RA) is known to be associated with increased cardiovascular (CV) disease due to classical risk factors and systemic inflammation (1). In the EULAR recommendations for CV risk management...

FRI0120 Marked underdiagnosis and undertreatment of hypertension and hypercholesterolemia in rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is recognized as an independent cardiovascular (CV) risk factor. The ongoing inflammatory state in RA is believed to be the main cause of this increased CV risk....

SAT0293 Comparison of european score and two national guidelines calibrated for cardiovascular risk assessment in patients with psoriatic arthritis

BackgroundStratifying cardiovascular risk using risk charts is central to decision-making on treatment to prevent cardiovascular disease. EULAR task force on cardiovascular (CV) risk management in patients (pts) with inflammatory arthritis...

FRI0107 A comparison of two methods of assessing cardiovascular risk in rheumatoid arthritis in a secondary care setting

BackgroundRheumatoid arthritis (RA) is associated with increased cardiovascular disease (CVD) risk. The UK National Institute of Health and Clinical Excellence recommends an annual CVD risk review1. EULAR suggests the increased...

THU0081 Assessing the cardiovascular risk burden in patients with rheumatoid arthritis: Role of annual review clinic

BackgroundRheumatoid arthritis (RA) is associated with the increased risk of cardiovascular (CV) mortality and morbidity [1]. There are recommendations by European League against Rheumatism (EULAR) and National Institute for Health...

SAT0570 Cardiovascular Risk and Statin Therapy in Rheumatoid Arthritis and Spondyloarthritis

BackgroundIndividual cardiovascular risk (CVR) in patients with inflammatory-rheumatic diseases can be estimated according to the SCORE-algorithm [1] and the EULAR recommendations for cardiovascular risk management [2].ObjectivesTo evaluate CVR in patients...

FRI0147 Screening for cardiovascular risk according to the eular recommendations in outpatients with rheumatoid arthritis reveals significant risk factors

BackgroundPersons with rheumatoid arthritis (RA) have an increased risk for development of cardio-vascular-disease (CVD) and screening is recommended (1).ObjectivesTo investigate the spread of risk factors for development of CVD and...

AB0391 Cardiovascular risk assessment in rheumatoid arthritis patients using the score chart

BackgroundThe European League Against Rheumatism (EULAR) published evidence-based recommendations to guide in the cardiovascular (CV) risk management in rheumatoid arthritis (RA) patients and other forms of inflammatory arthritis. In RA...

FRI0277 Cardiovascular risk assessment in patients with ankylosing spondilytis: Comparison of three indexes and related variables

BackgroundEULAR task force recommendations in the cardiovascular (CV) risk were published in 2010. EULAR recommends the use of the SCORE when no local guidelines are available. In our country, two...

The impact of psoriasis on 10-year Framingham risk

Psoriasis is a chronic inflammatory skin disease, and when severe, may be a risk factor for major adverse cardiac events (MACE) including myocardial infarction1, stroke and cardiovascular (CV) death. Indeed, recent studies evaluating the risk of MACE with IL-12/23 inhibitors in randomized trials emphasize the need for efforts at decreasing the risk of cardiovascular disease in psoriasis patients. 2. Risk stratification and treatment goals for cholesterol and blood pressure in psoriasis remains understudied, and the Framingham Risk score (FRS) for CV risk may underestimate long term risk of MACE in psoriasis patients. The Adult Treatment Panel for lipid management recommends that providers consider emerging risk factors when deciding on lipid treatment but does not provide specific guidelines. We described an initial estimate of this excess attributable risk of severe psoriasis on MACE3 and herein describe how this AR may affect FRS in psoriasis. We consecutively enrolled patients (n=138), and calculated FRS before and after adding the AR of psoriasis (6.2%)3, and estimated the reclassification rate by examining patients moved from a lower risk category to a higher risk category. Patients with psoriasis were relatively young with higher than expected tobacco use, alcohol use, body mass index and lipids (Table 1). Nonetheless, their risk for MACE by FRS was low (<10%) (male mean FRS 7.4 ± 7.75, female 5.9 ± 5.86), attributable to their young age. After considering the estimated AR, (mean FRS 13.36 ± 7.10, male 13.92 ± 7.77, female 12.48 ± 5.86), the majority of patients were re-classified to a higher-risk category: 73% (95% CI 61.5%–82.3%) of low risk patients were reclassified as intermediate, and 53% (95% CI 36.4%–64.1%) of intermediate risk patients were reclassified as high risk (Table 2). These findings suggest that adding the estimated AR of psoriasis on MACE to the FRS results in clinically important changes in prevention strategies3. Table 1 Demographic characteristics of study sample Table 2 Category of risk before and after adding psoriasis attributable risk with treatment goals Due to the young age of our population, the majority of patients were in the low risk category, which would not warrant aggressive risk reduction strategies. However, when considering an AR estimate of MACE, the majority of our patients were reclassified into the intermediate risk category which would warrant change in treatment plans and goals for over 60% of our patients (Table 2), an important finding in this population potentially at higher risk for CV disease with increased subclinical vascular inflammation4. We recognize this proof of concept study is limited by the generalizability of UK data to a US population. However, guidelines for identifying CVD risk factors are similar. Secondly, our AR was derived in severe psoriasis defined by treatment with systemic therapy or phototherapy; similarly, over 80% of our patients had been exposed to these therapies permitting this estimate to be applicable in this proof of concept study. The major implication of these findings is that patients with psoriasis may warrant more aggressive control of established CV risk factors. Measures to decrease CV risk include lifestyle and dietary education through targeted counseling. The percentage of these patients requiring drug interventions such as statins and anti-hypertensive is unknown but likely to be small. Finally, this illustration provides a quantitative approach for CV risk estimation in psoriasis, an approach gaining acceptance in the care of patients with rheumatoid arthritis5.