Rheumatoid arthritis

CV risk assessment in RA isn’t hard: Sattar


Assessing RA patients for cardiovascular risk can be simple, pragmatic, and easily incorporated into clinical practice, delegates have heard.

Speaking during an Outcome Science Session on Wednesday, Professor Naveed Sattar, a Professor of Metabolic Medicine at the University of Glasgow, stressed that cardiovascular risk for people with RA should involve considering traditional risk factors in addition to systemic disease and its severity.

“Traditional cardiovascular risk factors are really important – you cannot look at RA inflammation in isolation and think about CV disease, that’s complete nonsense, it doesn’t make sense,” he told the audience.

Professor Sattar said there was not enough data to support the use of an RA specific CV risk score.

To accommodate for RA he suggests using a risk score such as the Systematic Coronary Risk Evaluation (SCORE) algorithm and multiplying the score by 1.5 for all RA – a number recommended in the ESC guidelines published last week.

“Some of you may say that is too crude, but simplicity and pragmatism work every time,” Professor Sattar said.

“Get that right first and then you can become more refined should you wish to,” he said.

The EULAR guidelines were currently being revised and were likely to fall in line with this, he added.

Professor Sattar told the audience that there was a current fixation with fasting lipid tests yet they were not necessary.

The two lipid parameters tested – cholesterol and HDL cholesterol – changed minimally in fasting tests compared to non-fasting tests.

“If labs don’t test non-fasting lipids you need to challenge them – it’s rubbish – the evidence is there,” he said.

He suggested repeating the score in five years for patients with a low score, or sooner if they were close to the threshold.

In a nutshell: The take home message for clinicians:

Conduct CVD risk scoring in RA

  • RA clinic or primary care doctor
  • Add non-fasting lipids to kidney, liver biochemistry
  • Labs must test non-fasting samples – EHJ guidelines

Use SCORE and if RA multiply risk score by 1.5

  • Easiest and most pragmatic
  • Forget RA specific score

Then treat as indicated as per normal non-RA

– statins will work / BP reduction works

 

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