Male RA Patients with Increased Risk of Cardiovascular Mortality Compared to Women

The following is a summary of “Male rheumatoid arthritis patients at substantially higher risk for cardiovascular mortality in comparison to women,” published in the October 2023 issue of Arthritis and Rheumatism by Raadsen et al.

Patients with rheumatoid arthritis (RA) have an elevated risk of cardiovascular disease. In recent years, cardiovascular risk screening and management recommendations for patients with rheumatoid arthritis have been incorporated into several guidelines, but their implementation and adherence still need to be improved. The purpose of this study is to assess the risk of cardiovascular disease in newly diagnosed RA patients and to determine if the advice to initiate preventive medical treatment in patients at high risk was implemented. As part of standard care, the outpatient rheumatology clinic screened all patients with a recent diagnosis of RA, aged 40–70 years, for cardiovascular diseases and risk factors within the first year after diagnosis, between May 2019 and December 2022. The screening consisted of a physical examination with blood pressure measurement and laboratory procedures with lipid profile testing. 

All patients and their general practitioner (GP) received a summary of their cardiovascular risk profile and a 10-year cardiovascular mortality risk calculation. The cardiovascular risk was classified as low (10%). After screening, the national pharmacy network was consulted to determine whether or not patients began preventive medication. This research included a total of 125 RA patients. The average age was 56, and 78% were female. The median duration of RA at screening was six months. Six patients (5%) reported prior screening and use of antihypertensive medication. During screening, hypertension was detected in 57% of male patients and 43% of female patients, whereas dyslipidemia was detected in 36% of male patients and 31% of female patients. Currently, 46% of male patients and 21% of female patients smoke. 50% of male patients had a high or very high 10-year cardiovascular mortality risk, compared to 4% of female patients. After screening, only 26% of extremely high-risk patients began antihypertensive or statin treatment. 

A large proportion of newly diagnosed RA patients have undiagnosed and untreated hypertension and hypercholesterolemia, posing an increased risk for cardiovascular disease. This is particularly true for male patients. Even with structural screening and patient and GP education, treating cardiovascular risk factors in patients at high risk remains inadequate. Screening for CV risk must be a standard care element for RA patients, with primary and secondary care delineating their responsibilities. The significance of CVD risk screening must be better understood by both RA patients and their primary care physicians to reduce the cardiovascular burden of the researchers’ patients. Improved collaboration between primary care physicians and rheumatologists is urgently required to reduce their patients’ cardiovascular burden.

 Source: sciencedirect.com/science/article/pii/S0049017223000756