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Vol. 18. Issue 5.
Pages 266-272 (May 2022)
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Vol. 18. Issue 5.
Pages 266-272 (May 2022)
Original Article
Rheumatoid Arthritis, Statin Indication and Lipid Goals: Analysis According to Different Recommendations
Artritis reumatoide, indicación de estatinas y objetivos lipídicos: Análisis según diferentes recomendaciones
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Walter Massona,
Corresponding author
, Emiliano Rossia, Rodolfo N. Alvaradob, Guillermo Cornejo-Peñaa, Juan I. Damontea, Norberto Fiorinia, Lorena M. Mora-Crespoa, Mayra A. Tobar-Jaramillob, Marina Scolnikb
a Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
b Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
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Tables (2)
Table 1. Characteristics of rheumatoid arthritis patients at the evaluation time.
Table 2. Agreement in the indication of statins between the different strategies evaluated.
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Abstract
Background

Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA).

Objectives

(1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals.

Methods

A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor×1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed.

Results

A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals.

Conclusion

Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals.

Keywords:
Rheumatoid arthritis
Risk stratification
Risk scores
Statins
LDL-C goals
Resumen
Antecedentes

Se han propuesto diferentes estrategias para el manejo del riesgo cardiovascular en pacientes con artritis reumatoide (AR).

Objetivos

(1) estimar el riesgo cardiovascular mediante diferentes estrategias en pacientes con AR, analizando qué proporción de pacientes deberían recibir estatinas; (2) identificar cuántos pacientes alcanzaron los objetivos lipídicos recomendados.

Métodos

Estudio de corte transversal. Se estimaron los puntajes QRISK-3, Framingham (ajustado por un factor multiplicador × 1,5), ASCVD y SCORE. Se analizaron las indicaciones de estatinas, según las guías NICE, el Consenso Argentino, las guías ACC/AHA 2018 y las nuevas directrices europeas. Se analizaron los objetivos de C-LDL.

Resultados

Se incluyeron 420 pacientes; 24,7 y 48,7% de los pacientes en prevención primaria y secundaria recibían estatinas, respectivamente. El 19,4% de los pacientes con antecedentes cardiovasculares recibían estatinas de alta intensidad. Aplicando las guías ACC/AHA (basadas en el puntaje ASCVD), el Consenso Argentino (basado en el puntaje ajustado de Framingham), las pautas NICE (basadas en el QRISK-3) y las recomendaciones europeas (basadas en el SCORE), 26,9, 26,5, 41,1 y el 18,2% de la población eran elegibles para el tratamiento con estatinas, respectivamente. Siguiendo las nuevas recomendaciones europeas, 50, 46,2 y 15,9% de los pacientes con riesgo bajo-moderado, alto o muy alto lograron los objetivos lipídicos recomendados.

Conclusión

Aplicando varias estrategias para el manejo de los lípidos en nuestra población, la estratificación del riesgo cardiovascular y la indicación de estatinas fueron diferentes. Se observó una brecha significativa entre la indicación de estatinas esperada y observada, logrando los objetivos de C-LDL muy pocos pacientes.

Palabras clave:
Artritis reumatoide
Estratificación de riesgo
Puntuaciones de riesgo
Estatinas
Objetivos de C-LDL

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