Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam.
Department of Rheumatology, Antonius Hospital Zuidwest Friesland, Sneek.
Rheumatology (Oxford). 2017 Sep 1;56(9):1472-1478. doi: 10.1093/rheumatology/kew497.
To assess the 10-year cardiovascular (CV) risk score and to identify treatment and undertreatment of CV risk factors in patients with established RA.
Demographics, CV risk factors and prevalence of cardiovascular disease (CVD) were assessed by questionnaire. To calculate the 10-year CV risk score according to the Dutch CV risk management guideline, systolic blood pressure was measured and cholesterol levels were determined from fasting blood samples. Patients were categorized into four groups: indication for treatment but not treated; inadequately treated, so not meeting goals (systolic blood pressure ⩽140 mmHg and/or low-density lipoprotein ⩽2.5 mmol/l); adequately treated; or no treatment necessary.
A total of 720 consecutive RA patients were included, 375 from Reade and 345 from the Antonius Hospital. The mean age of patients was 59 years (s.d. 12) and 73% were female. Seventeen per cent of the patients had a low 10-year CV risk (<10%), 21% had an intermediate risk (10-19%), 53% a high risk (⩾20%) and 9% had CVD. In total, 69% had an indication for preventive treatment (cholesterol-lowering or antihypertensive drugs). Of those, 42% received inadequate treatment and 40% received no treatment at all.
Optimal CV risk management remains a major challenge and better awareness and management are urgently needed to reduce the high risk of CVD in the RA population.
评估 10 年心血管（CV）风险评分，并确定已确诊 RA 患者 CV 危险因素的治疗和治疗不足情况。
通过问卷评估人口统计学资料、CV 危险因素和心血管疾病（CVD）的患病率。为了根据荷兰 CV 风险管理指南计算 10 年 CV 风险评分，测量收缩压并从空腹血样中确定胆固醇水平。患者分为四组：有治疗指征但未治疗；治疗不足，未达到目标（收缩压⩽140mmHg 和/或低密度脂蛋白⩽2.5mmol/l）；充分治疗；或无需治疗。
共纳入 720 例连续 RA 患者，其中 375 例来自 Reade 医院，345 例来自 Antonius 医院。患者的平均年龄为 59 岁（标准差 12），73%为女性。17%的患者 10 年 CV 风险较低（<10%），21%处于中等风险（10-19%），53%处于高风险（⩾20%），9%患有 CVD。总体而言，69%有预防性治疗的指征（降脂或降压药物）。其中，42%接受了不充分的治疗，40%根本没有接受任何治疗。
最佳 CV 风险管理仍然是一个主要挑战，迫切需要提高认识和管理水平，以降低 RA 人群 CVD 的高风险。
