Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit

Abstract

Aim: The objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention.

Methods: The cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014-2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM.

Results: The study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM.

Conclusion: CVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA .

Keywords: arthritis; atherosclerosis; cardiovascular diseases; hypertension; lipids; rheumatoid.

Figure 1

Percentage of patients with RA with concomitant diagnosis of diabetes mellitus by country. The number over the bars are %. RA, rheumatoid arthritis.

Figure 2

Prevalence of cardiovascular diseases (CVDs) among patients with rheumatoid arthritis with diabetes mellitus (n=1381) and without diabetes mellitus (n=9162). AF, atrial fibrillation; ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; HF, heart failure; PAD, peripheral artery disease.

Figure 3

(A–D) Treatment target attainment for LDL-c and systolic BP among patients with RA with or without diabetes in primary prevention and secondary prevention by world regions. (A) LDL-c level in RA cases without ASCVD but with lipid-lowering agents for primary prevention. (B) LDL-c level in RA cases with ASCVD and in need of secondary prevention. (C) Systolic BP among patients with RA with antihypertensive drug treatment but no ASCVD. (D) BP among patients with RA with ASCVD. Red dashed lines depict commonly used treatment targets. Differences between patients with or without DM were compared with Mann-Whitney U test. The boxplots represent the distribution of measurements, with median as the black horizontal line in the middle of the box, IQR from 25th (Q1) to 75th (Q3) percentiles as the height of the box, and whiskers as Q1−1.5*IQR and Q3+1.5*IQR. Outliers are represented by grey dots. ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; DM, diabetes mellitus; LDL-c, low-density lipoprotein cholesterol; RA, rheumatoid arthritis.