Rheumatologists 'very poor' at managing cardiovascular risk in RA
SCOTTSDALE, Ariz. — Rheumatologists are often less familiar with, and need to better manage, cardiovascular risk factors in patients with rheumatoid arthritis, according to an expert at the annual Basic and Clinical Immunology for the Busy Clinician symposium.
“Recognizing the need for cardiovascular screening means needing to know what our patients are doing,” Elaine Husni, MD, MPH, vice chair of the department of rheumatic and immunologic diseases and director of the Arthritis Center at the Cleveland Clinic, told attendees. “Are they smoking? Are they overweight? We need to give them a plan. Unfortunately, what we see is that we are very poor at looking at cardiovascular risk factors. So, can we leverage other people to help? Should we send them to cardiologists? Who is responsible to managing this? Should this be up to primary care?”
Unfortunately, primary care physicians also tend to under-recognize cardiovascular risks in patients with RA, she added. According to Husni, just 30% to 50% of primary care physicians correctly identified RA as a risk factor for cardiovascular disease.
This lack of management of cardiovascular symptoms has resulted in only one in three patients with RA receiving annual risk factor screening, according to the Comorbidities in Rheumatoid Arthritis study, Husni said.
To combat this trend, rheumatologists at the Cleveland Clinic have instituted a best practice alert for cardiovascular risk factor management, called “Epic.” According to Husni, Epic uses electronic medical records to keep track of patients who have diagnoses associated with cardiovascular risk.
“If you have any of these diagnoses, our automatic best practice alert will pop up and you cannot go any further until you have referred to prevention cardiology,” Husni said. “We are lucky to have a group of cardiologists who understand our patient population. Also, when we send patients to them, they help us understand the guidelines.”
Husni noted that improving cardiovascular outcomes among patients with RA will require an ability to monitor or image subclinical disease, as well as the identification of relevant biomarkers to help providers evaluate subclinical disease. In addition, reducing cardiovascular mortality and morbidity will mean better risk stratification in systemic rheumatic diseases, as well as adequate disease control.
“Overall, in the big picture, we know that improving cardiovascular outcomes is probably not as simple as taking a drug that is just going to reduce inflammation,” Husni said. “There are different risk stratifications that we need to understand, and we need to identify some relevant biomarkers. We need to be aggressive about adequate disease control. We need to have a target, not just for joints but also cardiovascular comorbidity.” – by Jason Laday
Husni ME. Inflammation is the new cholesterol: Appraising the data and reducing risks of cardiovascular disease. Presented at: Seventh Annual Basic and Clinical Immunology for the Busy Clinician; February 15-16, 2019; Scottsdale, Ariz.
Disclosure: Husni reports no relevant financial disclosures.