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.
A Pilot Cardiovascular Risk Reduction Clinic for Inflammatory Rheumatic Diseases.
Martell, Kevin, McMurtry, Michael Sean, McAlister, Finlay, Gyenes, Gabor, Keeling, Stephanie O.
Background/Purpose:
A recent practice audit of 9 rheumatologists at a tertiary care site demonstrated poor cardiovascular (CV) risk management of inflammatory rheumatic disease (IRD) patients. Therefore the utility of a CV risk reduction clinic for these patients warrants investigation. This study established a new model-of-care independent of the standard rheumatology clinic and describes the original inception cohort.
Methods:
Patients with moderate to severe inflammatory arthritis (IA) were invited to attend the "CV Risk Reduction Clinic for IRD" as part of a biologics surveillance program in northern Alberta. After initial postal screening of traditional CV risk factors & fasting labs (lipid panel, glucose), clinic attendees were evaluated with pre-specified case report forms including IA activity and traditional CV risk factors. Framingham & Reynold's risk scores were calculated & the European League Against Rheumatism (EULAR) CV risk multiplicative factor of 1.5 applied when criteria were met. Carotid intima media thickness (CIMT) measurements were measured on a separate visit for all consenting patients. Patients were offered dietician counseling, smoking cessation therapies, physiotherapy referrals, lipid lowering (according to 2009 Canadian Cardiovascular Society guidelines) & antihypertensive treatments. RA disease management was left for the attending rheumatologist. Descriptive statistics were calculated with Microsoft excel & the study approved by the University of Alberta ethics.
Results:
Twenty-five patients (M:F 7:18) attended the clinic to date, mean age 55.8 (±13.5) years, with the following diagnoses: 19 (76%) RA; 2 (8%) juvenile idiopathic arthritis; 4 (16%) psoriatic arthritis. Fifteen (60%) patients were RF positive, 17 (68%) anti-CCP positive and 9 (36%) had rheumatoid nodules. Mean disease duration was 18±14 years, ESR 15 ± 12 mm/hr, CRP 5 ±4 mg/l & DAS28 2.5 ± 2.2. Radiographic erosions were noted in the hand and feet x-rays of 14 (58%) and 8 (38%) patients respectively. Traditional cardiovascular risk assessment confirmed four (16%) patients as active smokers, 10 (40%) with high cholesterol (LDL > 3.5 mmol/L), 2 (8%) with diabetes, 7 (28%) treated for systolic hypertension, 11 (44%) with family history of premature heart disease & 5 (20%) with personal history of CVD. The mean Framingham and Reynolds risk score of a CV event in the next 10-years was 10% and 2.2% & the mean Framingham applying the EULAR multiplicative factor (8 patients) was 8.0%. Mean CIMT measurement for any observed carotid artery was 0.70 mm (± 0.21; n=74 arteries), & number of arteries with significant thickness (>0.75 mm) was 27 with mean thickness of 0.96 ± 0.15 mm. Plaques were noted in 6 patients.
Conclusion:
The CRRC-IRD provides a new model-of-care to evaluate and manage CV risk in a high-risk patient population. Future evaluations from this clinic model include (1) reviewing prospective CV outcomes from the clinic compared to standard-of-care, (2) applicability of different risk scores in IA (given the discrepancy of mean Framingham & Reynold's scores in this study) & (3) contributions of treat-to-target RA disease approach & (4) CIMT to CV risk assessment.
To cite this abstract, please use the following information:
Martell, Kevin, McMurtry, Michael Sean, McAlister, Finlay, Gyenes, Gabor, Keeling, Stephanie O.; A Pilot Cardiovascular Risk Reduction Clinic for Inflammatory Rheumatic Diseases. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2078
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