Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


An Analysis of the Use of Lipid Lowering Agents in Rheumatoid Arthritis: A Population Based Cohort Study.

Akkara Veetil,  Bharath Manu, Matteson,  Eric L., Gabriel,  Sherine E., Crowson,  Cynthia S.

Background/Purpose:

Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease and mortality. Lipid lowering therapy to reduce risk for major coronary events and coronary death is reportedly underused in patients with RA, but it is unknown whetheruse of lipid lowering medications in patients with RA differs from the general population.

Methods:

A population-based inception cohort of patients who fulfilled 1987 American College of Rheumatology criteria for RA in 1988–2007 and a cohort of non-RA subjects from the same population base were assembled and followed until death, migration, or 12/31/2008. Cardiovascular risk factors, lipid measures and use of lipid-lowering agents were ascertained by review of the medical record. The national cholesterol education program (NCEP) adult treatment panel III (ATP III) guidelines were assessed at the time of each lipid measure throughout follow-up. Time from the first measurement of lipids meeting guidelines for initiation of lipid-lowering agents to initiation of lipid-lowering agents was assessed using Kaplan-Meier methods. Log rank tests were used to compare RA and non-RA cohorts.

Results:

The study population included 412 RA and 438 non-RA patients with at least one lipid measure during follow-up and no prior use of lipid-lowering agents (mean age 60 years; 71% female in each cohort). No difference between RA and non-RA cohorts was found in the time from index date to the first lipid measure (p=0.68). The rates of lipid testing were lower among patients with RA compared to non-RA subjects, with 2209 lipid tests during 4454 person-years (0.50 per patient per year; 95% CI: 0.48, 0.52) in the patients with RA and 2780 lipid tests during 5119 person-years (0.54 per patient per year; 95% CI: 0.52, 0.56) in the non-RA subjects (p<0.001). Overall, patients with RA were less likely to receive lipid-lowering agents than non-RA subjects with 21% of RA and 28% of non RA subjects initiating lipid lowering therapy by 10 years(p=0.02). The NCEP ATP III cardiovascular disease risk categories were similar in both cohorts (p=0.48). Among patients who met NCEP ATP III criteria for lipid lowering therapy during follow-up (n=106 RA and n=120 non-RA), there was no difference between patients with RA and non-RA in initiation of lipid lowering therapy (27% in RA vs 26% in non-RA, p=0.36). In the subset of subjects with LDL>=160 mg/dl, there was no difference between RA and non-RA in initiation of lipid lowering therapy, with 24% of RA and 26% of non-RA patients initiating lipid-lowering agents within 2 years (p=0.77).

Conclusion:

Patients with RA were less likely to receive lipid-lowering agents than non-RA subjects overall. However, among those who met NCEP ATP III criteria recommending initiation of lipid-lowering agents, the percentage of RA and non-RA patients who initiated lipid-lowering agents was similar. Substantial undertreatment occurred in both the RA and non-RA cohorts.

To cite this abstract, please use the following information:
Akkara Veetil, Bharath Manu, Matteson, Eric L., Gabriel, Sherine E., Crowson, Cynthia S.; An Analysis of the Use of Lipid Lowering Agents in Rheumatoid Arthritis: A Population Based Cohort Study. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :121
DOI:

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