Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice.

Ann Rheum Dis 2014 Jul 7;73(7):1284-8. Epub 2014 Mar 7.

Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

As physicians we like to have evidence for making decisions about interventions to improve health. The evidence vacuum in the field of cardiovascular disease (CVD) prevention and clinical outcome in patients with rheumatoid arthritis (RA) has received vigorous attention in the recent literature. There is broad agreement that a patient with RA fulfilling the criteria established for the general population on CVD risk reduction should receive proven interventions, including smoking cessation, weight reduction, blood pressure control and lipid-lowering therapy. In accordance with these recommendations, and despite all the uncertainties about CVD treatment threshold, targets and outcome results in RA, we firmly advocate that CVD risk should be assessed and acted on in patients with RA as recommended for the general population, even while educational CVD-preventive programmes are being developed and hard CVD end point studies are undertaken in this patient population. The initial strategies for implementing CVD risk evaluation will necessarily be modest at first. There are several possible strategies for collection of data that can be incorporated into the daily routine during rheumatology consultations at outpatient clinics. We recommend starting with these simple procedures: 1. CVD risk factor recording and evaluation using risk calculators available for the general population 2. Referral of patients with high CVD risk to a primary care physician or a cardiologist skilled in this subject for follow-up 3. Providing information about excess CVD risk and how to modify it to the patients as major stakeholders.

Download full-text PDF

Source
http://dx.doi.org/10.1136/annrheumdis-2013-204792DOI Listing
July 2014
23 Reads

Publication Analysis

Top Keywords

cvd risk
24
general population
12
cvd
9
risk
8
rheumatoid arthritis
8
cardiovascular disease
8
pressure control
4
calculators general
4
risk evaluation
4
blood pressure
4
control lipid-lowering
4
reduction blood
4
population referral
4
therapy recommendations
4
recording evaluation
4
despite uncertainties
4
recommendations despite
4
evaluation risk
4
lipid-lowering therapy
4
referral patients
4

References

(Supplied by CrossRef)
Focus on effective implementation of cardiovascular risk factor recording in a rheumatology outpatient clinic
Ikdahl et al.
Arthritis Rheum 2013
Rheumatoid factor, smoking, and disease severity: associations with mortality in rheumatoid arthritis
Goodson et al.
J Rheumatol 2008

Similar Publications