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DiGregorio H, Avenatti E, Gullapelli R, Williams K, El Hajj E, Foster C, Das S, Shahid I, Shah A, Nicolas J, Bose B, Hagan K, Lahan S, Nwana N, Butt S, Javed Z, Karam LR, Monga K, Guevara M, Weber B, Patel K, Al-Kindi SG, Nasir K. Burden of Atherosclerotic Disease Risk Factors in Patients With and Without Rheumatologic Disease: A Retrospective Cohort Study. Am J Cardiol 2024; 230:S0002-9149(24)00619-2. [PMID: 39218055 DOI: 10.1016/j.amjcard.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/17/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Helene DiGregorio
- Departments of Internal Medicine, Houston Methodist Hospital, Houston, Texas.
| | | | - Rakesh Gullapelli
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Kenneth Williams
- Departments of Internal Medicine, Houston Methodist Hospital, Houston, Texas
| | - Elia El Hajj
- Departments of Internal Medicine, Houston Methodist Hospital, Houston, Texas
| | - Charles Foster
- Texas A&M University School of Engineering in Medicine, Houston, Texas
| | - Siddharth Das
- Departments of Internal Medicine, Houston Methodist Hospital, Houston, Texas
| | - Izza Shahid
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Aayush Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Juan Nicolas
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Budhaditya Bose
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Kobina Hagan
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Shubham Lahan
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Nwabunie Nwana
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Sara Butt
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Zulqarnain Javed
- Houston Methodist Research Institute-Center for Cardiovascular Computational and Precision Health, Houston, Texas
| | - Lily Romero Karam
- Departments of Internal Medicine-Rheumatology, Houston Methodist Hospital, Houston, Texas
| | - Kanika Monga
- Departments of Internal Medicine-Rheumatology, Houston Methodist Hospital, Houston, Texas
| | - Myriam Guevara
- Departments of Internal Medicine-Rheumatology, Houston Methodist Hospital, Houston, Texas
| | - Brittany Weber
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kershaw Patel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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Bolla E, Semb AG, Kerola AM, Ikdahl E, Petri M, Pons-Estel GJ, Karpouzas GA, Sfikakis PP, Quintana R, Misra DP, Borba EF, Garcia-de la Torre I, Popkova TV, Artim-Esen B, Troldborg A, Fragoso-Loyo H, Ajeganova S, Yazici A, Aroca-Martinez G, Direskeneli H, Ugarte-Gil MF, Mosca M, Goyal M, Svenungsson E, Macieira C, Hoi A, Lerang K, Costedoat-Chalumeau N, Tincani A, Mirrakhimov E, Acosta Colman I, Danza A, Massardo L, Blagojevic J, Yılmaz N, Tegzová D, Yavuz S, Korkmaz C, Hachulla E, Moreno Alvarez MJ, Muñoz-Louis R, Pantazis N, Tektonidou MG. Prevalence and target attainment of traditional cardiovascular risk factors in patients with systemic lupus erythematosus: a cross-sectional study including 3401 individuals from 24 countries. THE LANCET. RHEUMATOLOGY 2024; 6:e447-e459. [PMID: 38878780 DOI: 10.1016/s2665-9913(24)00090-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is characterised by increased cardiovascular morbidity and mortality risk. We aimed to examine the prevalence of traditional cardiovascular risk factors and their control in an international survey of patients with systemic lupus erythematosus. METHODS In this multicentre, cross-sectional study, cardiovascular risk factor data from medical files of adult patients (aged ≥18) with SLE followed between Jan 1, 2015, and Jan 1, 2020, were collected from 24 countries, across five continents. We assessed the prevalence and target attainment of cardiovascular risk factors and examined potential differences by country income level and antiphospholipid syndrome coexistence. We used the Systemic Coronary Risk Evaluation algorithm for cardiovascular risk estimation, and the European Society of Cardiology guidelines for assessing cardiovascular risk factor target attainment. People with lived experience were not involved in the research or writing process. FINDINGS 3401 patients with SLE were included in the study. The median age was 43·0 years (IQR 33-54), 3047 (89·7%) of 3396 patients were women, 349 (10.3%) were men, and 1629 (48·1%) of 3390 were White. 556 (20·7%) of 2681 patients had concomitant antiphospholipid syndrome. We found a high cardiovascular risk factor prevalence (hypertension 1210 [35·6%] of 3398 patients, obesity 751 [23·7%] of 3169 patients, and hyperlipidaemia 650 [19·8%] of 3279 patients), and suboptimal control of modifiable cardiovascular risk factors (blood pressure [target of <130/80 mm Hg], BMI, and lipids) in the entire SLE group. Higher prevalence of cardiovascular risk factors but a better blood pressure (target of <130/80 mm Hg; 54·9% [1170 of 2132 patients] vs 46·8% [519 of 1109 patients]; p<0·0001), and lipid control (75·0% [895 of 1194 patients] vs 51·4% [386 of 751 patients], p<0·0001 for high-density lipoprotein [HDL]; 66·4% [769 of 1158 patients] vs 60·8% [453 of 745 patients], p=0·013 for non-HDL; 80·9% [1017 of 1257 patients] vs 61·4% [486 of 792 patients], p<0·0001 for triglycerides]) was observed in patients from high-income versus those from middle-income countries. Patients with SLE with antiphospholipid syndrome had a higher prevalence of modifiable cardiovascular risk factors, and significantly lower attainment of BMI and lipid targets (for low-density lipoprotein and non-HDL) than patients with SLE without antiphospholipid syndrome. INTERPRETATION High prevalence and inadequate cardiovascular risk factor control were observed in a large multicentre and multiethnic SLE cohort, especially among patients from middle-income compared with high-income countries and among those with coexistent antiphospholipid syndrome. Increased awareness of cardiovascular disease risk in SLE, especially in the above subgroups, is urgently warranted. FUNDING None.
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Affiliation(s)
- Eleana Bolla
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Research and Innovation, REMEDY Centre, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne M Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland; Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Division of Research and Innovation, REMEDY Centre, Diakonhjemmet Hospital, Oslo, Norway
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - George A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, USA; The Lundquist Institute, Torrance, CA, USA
| | - Petros P Sfikakis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Rosana Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Argentina
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Eduardo Ferreira Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ignacio Garcia-de la Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente, Jalisco, Mexico; Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Bahar Artim-Esen
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Hilda Fragoso-Loyo
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sofia Ajeganova
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ayten Yazici
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | | | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Türkiye
| | - Manuel F Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Peru; Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Mohit Goyal
- Division of Rheumatology, CARE Pain and Arthritis Centre, Udaipur, India
| | - Elisabet Svenungsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisboa, Portugal
| | - Alberta Hoi
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia; School of Clinical Science, Monash University, Clayton, VIC, Australia
| | - Karoline Lerang
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Nathalie Costedoat-Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit-ASST Spedali Civili, Brescia, Italy
| | | | - Isabel Acosta Colman
- Department of Rheumatology, Universidad Nacional de Asunción, Asuncion, Paraguay
| | - Alvaro Danza
- Department of Internal Medicine, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Jelena Blagojevic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, AOUC, Florence, Italy
| | - Neslihan Yılmaz
- Rheumatology Department, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Türkiye
| | - Dana Tegzová
- Institute of Rheumatology, Prague, Czech Republic
| | - Sule Yavuz
- Department of Internal Medicine, Division of Rheumatology, Istanbul Bilim University, Istanbul, Türkiye
| | - Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, National Referral Centre for Rare Systemic Auto-Immune and Auto-inflammatory Diseases, University of Lille, Inserm, CHU Lille, U1286 - INFINITE, University of Lille, Lille, France
| | - Mario J Moreno Alvarez
- Servicio Reumatología, Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
| | - Roberto Muñoz-Louis
- Servicio de Reumatología, Hospital Docente Padre Billini, Santo Domingo, Dominican Republic
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
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Avagimyan A, Fogacci F, Pogosova N, Kakturskiy L, Jndoyan Z, Faggiano A, Bairamyan T, Agati L, Sattar Y, Mkrchyan L, Avetisyan G, Ginosyan K, Aznauryan A, Sahakyan K, Trofimenko A, Urazova O, Mikhaleva L, Vandysheva R, Kogan E, Demura T, Kc M, Shafie D, Nicola S, Brussino L, Cicero A, Biondi-Zoccai G, Sarrafzadegan N. Methotrexate & rheumatoid arthritis associated atherosclerosis: A narrative review of multidisciplinary approach for risk modification by the international board of experts. Curr Probl Cardiol 2024; 49:102230. [PMID: 38040221 DOI: 10.1016/j.cpcardiol.2023.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
Rheumatoid arthritis (RA) is an idiopathic, autoimmune connective tissue disorder that primarily affects the synovial joints, causing symmetric, erosive-deforming polyarthritis. It is also associated with extra-articular manifestations, particularly cardiovascular (CV) diseases (CVD). CV risk modification in RA remains unsolved despite recent advances in the management of RA. RA is an independent risk factor for atherosclerosis. RA and atherosclerosis share similar pathophysiological features (such as the pro-inflammatory cascade activation including interleukin-6) and risk factors (such as microflora dysbacteriosis and smoking). Patients with RA experience an exacerbation of atherogenesis, with atheromas destabilization, endothelial dysfunction, vasculitis, and hypercytokinemia. Consequently, the inflammatory response associated with RA is the basis for CVD development. The treat-to-target strategy not only improved RA control but also had a favorable effect on the morpho-functional state of the CV system in patients living with RA. Thus, disease-modifying antirheumatic drugs (DMARDs) - in particular methotrexate - may have a beneficial effect on the prevention of CV events in RA. It must be mentioned that RA is a serious multi-system disease, not only because of a window period during which the course of RA can be reversed, but also due to early damage to the heart and blood vessels. For this reason, a thorough cardiological assessment must be performed for all patients with RA, regardless of sex, age, disease stage, and disease activity score.
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Affiliation(s)
- Ashot Avagimyan
- MD, PhD, Assistant Professor, Department of Anatomical Pathology and Clinical Morphology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
| | - Federica Fogacci
- MD, Research Fellow, Atherosclerosis and Metabolic Disorders Research Unit, University of Bologna, Bologna, Italy
| | - Nana Pogosova
- MD, PhD, Professor, Head of Laboratory of Preventive Cardiology, Deputy Director for Science and Preventive Cardiology, National Medical Research Center of Cardiology named after academician E. Chazov, Moscow, Russia
| | - Lev Kakturskiy
- MD, Ph.D, Scientific Director, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia
| | - Zinaida Jndoyan
- MD, PhD, Head of Internal Diseases Propaedeutic Department, Head of Internal Medicine Unit of University Clinical Hospital, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Andrea Faggiano
- MD, PhD, Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Clinical Sciences and Community Health, University of Milano, Italy
| | - Tamara Bairamyan
- MD, PhD, Associate Professor, Department of Rheumatology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Luciano Agati
- MD, PhD, Head of Cardiology Unit Aziendo Umberto II, Department of Cardiology, La Sapienza University of Rome, Rome, Italy
| | - Yasar Sattar
- MD, Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Lusine Mkrchyan
- MD, PhD, Associate Professor, Department of Cardiology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Gayane Avetisyan
- MD, PhD, Associate Professor, Department of Topographical Anatomy and Operative Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Knarik Ginosyan
- MD, PhD, Head of Rheumatology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Anahit Aznauryan
- PhD, Associate Professor, Histology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Karmen Sahakyan
- PhD, Professor, Head of Histology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Artem Trofimenko
- MD, PhD, Associate Professor, Department of Pathophysiology, Kuban State Medical University, Krasnodar, Russia
| | - Olga Urazova
- MD, PhD, Professor, Head of Pathophysiology Department, Siberian State Medical University, Tomsk, Russia
| | - Liudmila Mikhaleva
- MD, PhD, Director, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia
| | - Rositsa Vandysheva
- MD, PhD, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia
| | - Eugenia Kogan
- MD, PhD, Professor, Head of Anatomical Pathology Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tatiana Demura
- MD, PhD, Professor, Director of Institute of Clinical Morphology and Digital Pathology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Manish Kc
- MD, North Alabama Medical Centre, Florence, Alabama, USA
| | - Davood Shafie
- MD, PhD, Director of Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Stefania Nicola
- MD, PhD, Immunology and Allergy Unit, AO Ordine Mauriziano di Torino and Department of Medical Sciences, University of Turin, Italy
| | - Luisa Brussino
- MD, PhD, Director of the Allergy and Immunology unit AO Ordine Mauriziano di Torino - Department of Medical Sciences, University of Turin, Italy
| | - Arrigo Cicero
- MD, PhD, Professor, Atherosclerosis and Metabolic Disorders Research Unit, University of Bologna, Bologna, Italy
| | - Giuseppe Biondi-Zoccai
- MD, PhD, Professor, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Nizal Sarrafzadegan
- MD, Professor, Director of Isfahan Cardiovascular Research Center (WHO Collaboration Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Agewall S. Cardiovascular prevention and risk factors. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:1-2. [PMID: 38000082 DOI: 10.1093/ehjcvp/pvad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Stefan Agewall
- Institute of Clinical Sciences, Karolinska Institute of Danderyd, Stockholm, Sweden
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Fares J, Summer R, Loizidis G. Low utilization of statins in patients with dermatomyositis/polymyositis and hyperlipidemia: a multicenter USA-based study (2013-2023). Clin Rheumatol 2024; 43:325-338. [PMID: 37930595 DOI: 10.1007/s10067-023-06801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE While the cardioprotective benefits of statins for rheumatoid arthritis (RA) patients are well-established, there might be a hesitation in recommending them for dermatomyositis/polymyositis (DM/PM) patients with hyperlipidemia (HLD), particularly with myopathy. We sought to contrast statin prescription patterns between DM/PM-HLD and RA-HLD patients and delve into the mortality variations among DM/PM-HLD statin users and non-users. METHODS We examined a decade's worth of anonymized US health data from the TriNetX database. Inclusion criteria were a subsequent HLD diagnosis after an initial DM/PM or RA diagnosis. We compared statin initiation rates and mortality outcomes, adjusting for demographics and cardiovascular risks through propensity score matching. RESULTS The analysis comprised 33,000 RA-HLD and 1079 DM/PM-HLD patients. RA-HLD patients exhibited higher statin initiation (27.4%) than DM/PM-HLD patients (17.91%, p < 0.0001). Notably, DM/PM-HLD statin users (n = 311) presented a reduced mortality rate (75 deaths/1000/year) compared to non-users (n = 661) with 147 deaths/1000/year (p = 0.0273, HR = 0.515, CI 0.28-0.93). CONCLUSION There is a marked disparity in statin initiation between DM/PM-HLD and RA-HLD patients, accompanied by elevated mortality in DM/PM-HLD non-users. It is imperative for further research to elucidate this discrepancy and formulate patient-centric cardiovascular guidelines for DM/PM-HLD patients. Key Points • Statin initiation among patients with DM/PM-HLD is significantly lower than that with RA-HLD. • Mortality rates within the statin initiator DM/PM-HLD were significantly lower compared to non-statin DM/PM-HLD initiators, spanning multiple time intervals.
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Affiliation(s)
- Joseph Fares
- Division of Pulmonary and Critical Care, Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ross Summer
- Division of Pulmonary and Critical Care, Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Giorgos Loizidis
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
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Muhammed H, Misra DP, Jain N, Ganguly S, Pattanaik SS, Rai MK, Anuja AK, Mohindra N, Kumar S, Agarwal V. The comparison of cardiovascular disease risk prediction scores and evaluation of subclinical atherosclerosis in rheumatoid arthritis: a cross-sectional study. Clin Rheumatol 2022; 41:3675-3686. [PMID: 36006556 DOI: 10.1007/s10067-022-06349-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/28/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Primary objectives estimated prevalence of traditional cardiovascular disease (CVD) risk factors and compared different CVD risk prediction algorithms in an Indian rheumatoid arthritis (RA) population. Secondary objectives evaluated associations between carotid intima-media thickness (CIMT) and subclinical atherosclerosis (SCA) with CVD risk factors and CVD risk scores. METHODS The presence of CVD risk factors were recorded, and 10-year CVD risk was predicted using Framingham risk scoring (FRS) using lipids (FRS-Lipids), FRS using body mass index (FRS-BMI), QRISK-2, SCORE, and the algorithm recommended by ACC/AHA (ASCVD). CIMT was measured on the far-wall of the common carotid artery. Subclinical atherosclerosis was defined as CIMT > 0.9 mm or the presence of carotid plaque. RESULTS A total of 332 patents were enrolled, 12% had diabetes mellitus, 21.4% hypertension, and 6.9% were current/past smokers. Proportions of RA with predicted 10-year CVD risk > 10% varied from 16.2 to 41.9% between scores. Highest magnitude of risk was predicted by FRS-BMI. Agreement between scores in predicting risk was moderate in general. Mean CIMT was 0.70 ± 0.15 mm. Age, male sex, and extra-articular manifestations associated with greater CIMT. All risk scores except SCORE moderately correlated with CIMT. About one-seventh had SCA defined as CIMT > 0.9 mm or the presence of carotid plaques, associated with increasing age, male gender, or higher ratio of total cholesterol to high-density lipoprotein cholesterol. ASCVD and QRISK-2 scores had maximum area under curve for distinguishing SCA. CONCLUSION Individual CVD risk scores predict 10-year CVD risk differently in Indian patients with RA, and require validation for predicting hard end points (CVD events, mortality). Key Points • Diabetes mellitus and hypertension are the most prevalent cardiovascular disease risk factors in Indian patients with RA. • Individual cardiovascular risk prediction scores predict risk differently in Indian patients with RA, highest risk being predicted by the FRS-BMI. • Carotid intima-media thickness in RA associated with increasing age, male sex and extra-articular manifestations. • 14% RA had subclinical atherosclerosis, associated with increasing age, male sex, and higher total cholesterol to HDL-C ratio, best distinguished by ASCVD and QRISK-2 scores.
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Affiliation(s)
- Hafis Muhammed
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Neeraj Jain
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sujata Ganguly
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sarit Sekhar Pattanaik
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohit K Rai
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anamika Kumari Anuja
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Namita Mohindra
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Nordén KR, Dagfinrud H, Semb AG, Hisdal J, Viktil KK, Sexton J, Fongen C, Skandsen J, Blanck T, Metsios GS, Tveter AT. Effect of high-intensity exercise on cardiorespiratory fitness, cardiovascular disease risk and disease activity in patients with inflammatory joint disease: protocol for the ExeHeart randomised controlled trial. BMJ Open 2022; 12:e058634. [PMID: 35177467 PMCID: PMC8860070 DOI: 10.1136/bmjopen-2021-058634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Inflammatory joint disease (IJD) is associated with increased risk of cardiovascular disease (CVD) fostered by systemic inflammation and a high prevalence of CVD risk factors. Cardiorespiratory fitness (CRF) is an important health parameter and CRF-measures are advocated in routine health evaluations. CRF associates with CVD risk, and exercise modalities such as high intensity interval training (HIIT) can increase CRF and mitigate CVD risk factors. In IJD, exercise is rarely used in CVD risk management and the cardioprotective effect of HIIT is unclear. Furthermore, the clinical applicability of HIIT to primary care settings is largely unknown and warrants investigation. The primary aim is to assess the effect of a HIIT programme on CRF in patients with IJD. Second, we will evaluate the effect of HIIT on CVD risk and disease activity in patients with IJD, feasibility of HIIT in primary care and validity of non-exercise algorithms to detect change in CRF. METHODS AND ANALYSIS ExeHeart is a single-blinded, randomised controlled trial. Sixty patients with IJD will be recruited from the Preventive Cardio-Rheuma clinic at Diakonhjemmet Hospital, Norway. Patients will be assigned to receive standard care (relevant lifestyle advice and cardio-preventive medication) or standard care plus a 12-week HIIT intervention by physiotherapists in primary care. HIIT sessions will be prescribed at 90%-95% of peak heart rate. Outcomes include CRF (primary outcome), CVD risk factors, anthropometric measures, disease activity and patient-reported outcomes related to pain, fatigue, disease, physical activity and exercise and will be assessed at baseline, 3 months (primary endpoint) and 6 months postbaseline. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Committee for Medical and Health Research Ethics (201227). Participants are required to sign a written informed consent form. Results will be discussed with patient representatives, submitted to peer-reviewed journals and presented at relevant platforms. TRIAL REGISTRATION NUMBER NCT04922840.
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Affiliation(s)
- Kristine Røren Nordén
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Dagfinrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of vascular surgery, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Kirsten K Viktil
- Department of Pharmacy, University of Oslo, Oslo, Norway
- Diakonhjemmet Hospital Pharmacy, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Patient advisory board, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Patient advisory board, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Volos, Thessaly, Greece
| | - Anne Therese Tveter
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Raveendran AV, Ravindran V. Clinical inertia in rheumatology practice. J R Coll Physicians Edinb 2021; 51:402-406. [PMID: 34882145 DOI: 10.4997/jrcpe.2021.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Several professional medical learned societies and organisations have recommended guidelines for management of various chronic diseases geared to achieve optimal control over the diseases and improve the quality of care. However, the data from around the world suggest that a majority of patients are not achieving those treatment targets. This has been well documented in diseases such as diabetes, hypertension, dyslipidaemia and rheumatoid arthritis, and clinical inertia is thought to be a major factor responsible. In this article, we have discussed clinical inertia in rheumatology practice, which has relevance to several other chronic non-communicable diseases as well.
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Li Y, Narisawa M, Huang Z, Meng X, Wang H, Jin X, Shen X, Cheng XW. Expanding role for single-pill combination drug therapy in the initial treatment of hypertension? J Clin Hypertens (Greenwich) 2021; 23:1984-1986. [PMID: 34657362 PMCID: PMC8630603 DOI: 10.1111/jch.14378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Yanglong Li
- Department of Oncology, Yanbian University Hospital, Yanjin, Jilin, PR China
| | - Megumi Narisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Zhe Huang
- Department of Oncology, Yanbian University Hospital, Yanjin, Jilin, PR China
| | - Xiangkunm Meng
- Department of Oncology, Yanbian University Hospital, Yanjin, Jilin, PR China
| | - Hailong Wang
- Department of Oncology, Yanbian University Hospital, Yanjin, Jilin, PR China
| | - Xueying Jin
- Department of Oncology, Yanbian University Hospital, Yanjin, Jilin, PR China
| | - Xionghu Shen
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Xian Wu Cheng
- Department of Cardiology, Yanbian University Hospital, Yanjin, Jilin, PR China
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