NEWS - Researchers unveil new cardiovascular risk-assessment system

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Researchers unveil new cardiovascular risk-assessment system

Rheumawire

Aug 31, 2005

Gandey

Cambridge, UK - Assessing cardiovascular risk in patients with chronic

rheumatic diseases presents unique challenges for rheumatologists. In a

paper published online August 2, 2005 in Rheumatology, two investigators

present a new risk-reduction system to help demystify the process [1]. Lead

author Dr Frances Hall (Addenbrooke's Hospital, Cambridge, UK) said during

an interview that more clinicians are realizing the important role

cardiovascular risk reduction plays in rheumatoid arthritis (RA), systemic

lupus erythematosus (SLE), and related conditions. " Rheumatologists have

been focused on protecting joints and bones and minimizing disease activity.

But we are now realizing that they must also focus on blood vessels and

minimizing cardiovascular risk. " For this, Hall says, there will be a

sometimes-steep learning curve.

As previously reported by rheumawire, research presented at the 2004

European League Against Rheumatism meeting showed that cardiovascular risks

are being overlooked in arthritis. Reporting the findings of his group's

work, lead author Dr Gurkipal Singh (Stanford University School of Medicine,

Los Angeles, CA) said at the time, " The cardiovascular risks attributable to

RA have been underrecognized. The result is that more patients with RA are

presenting with heart attacks requiring hospital treatment. No improvement

in hospital mortality following acute myocardial infarction in the RA

population has been seen in the past 10 years. " He added that this is in

contrast to the situation observed in diabetes. " The cardiovascular

complications of diabetes are well recognized, and there have been major

improvements in the prevention and treatment of heart disease in these

patients. "

In the present paper, Hall, along with coauthor Dr Nicola Dalbeth

(University of Auckland, New Zealand), review the evidence for the efficacy

of a range of therapeutic strategies that influence both cardiovascular risk

and rheumatic disease activity. They based their work on recent publications

as well as on advice from specialist panels from the National Cholesterol

Education Program and the British Hypertension Society. Working to simplify

what they found for those in practice, Hall and Dalbeth developed an

algorithm. " We are looking to minimize clinic time and resources by offering

physicians a means of stratifying patients into groups for risk management. "

They suggest the following three categories of risk: routine, substantial,

and intensive.

Approached by rheumawire for comment, Dr Zashin, a Dallas, TX-based

rheumatologist, agrees with the take-home message of the paper that patients

with rheumatic diseases may be at increased risk of cardiovascular

complications. " It's true that in the past rheumatologists didn't address

these issues. We are in a position now where we are going to have to

consider the whole patient and make necessary treatment recommendations such

as prescribing a lipid-lowering agent or making appropriate referrals. " But

Zashin cautions that more study is needed and adds that he is hesitant to

assume this link is conclusive. " This is a fluid subject, and we may very

well discover down the road that there is no increased risk. "

Zashin also critiques the article, arguing that the work is not as user

friendly as intended. " I wasn't impressed with how they wrote the article, "

he said, noting that it perhaps covers too much therapeutic ground and is

" confusing. " Zashin says he wonders how much the average practitioner will

glean from this article.

Hall acknowledges that coming to grips with the algorithm may present a

challenge for many clinicians. " It's difficult for practitioners in a busy

clinic to get on top of something new in addition to everything else they

already have to do. " She recommends that doctors consider printing out

copies of the algorithm and keeping them on hand in the clinic. " What

rheumatologists should focus on above all else are risk factors, " Hall told

rheumawire.

Hall and Dalbeth conclude that the management of cardiovascular risk should

be much more aggressive than is currently the norm in patients with chronic

inflammatory diseases. Hall adds that rheumatologists will increasingly need

to apprise themselves of therapeutic options such as statins,

angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers.

Source

1. Hall FC, Dalbeth N. Disease modification and

cardiovascular risk reduction: Two sides of the same coin? Rheumatology

2005; DOI:10.1093/rheumatology/kei012. Available at:

http://rheumatology.oxfordjournals.org.

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