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

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001724
Author(s):  
Anne Grete Semb ◽  
Silvia Rollefstad ◽  
Eirik Ikdahl ◽  
Grunde Wibetoe ◽  
Joseph Sexton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Goal Attainment ◽  
Disease Risk ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Preventive Medication ◽  
Study Population

AimThe 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.MethodsThe 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.ResultsThe 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.ConclusionCVD 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 .

scholarly journals Risk factors for venous thromboembolism and atherosclerotic cardiovascular disease: do they differ in patients with rheumatoid arthritis?

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001618
Author(s):  
Gulsen Ozen ◽  
Sofia Pedro ◽  
Rebecca Schumacher ◽  
Teresa Simon ◽  
Kaleb Michaud
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Venous Thromboembolism ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cox Proportional Hazards ◽  
Hospital Death ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk

ObjectiveVenous thromboembolism (VTE) is an increasing concern in rheumatoid arthritis (RA) with little known about risk factors. We aimed to compare risk factors for unprovoked VTE and atherosclerotic cardiovascular disease (ASCVD) in patients with RA and to assess subsequent ASCVD risk after an unprovoked VTE.MethodsPeople with RA participating in a US-wide longitudinal observational registry from 1998 to 2018 were assessed for incident unprovoked VTE (deep venous thrombosis and pulmonary emboli not associated with cancer, recent surgery, hospitalisation, fracture and pregnancy) and ASCVD (myocardial infarction and stroke) validated from hospital/death records. Risk factors for VTE and ASCVD and the risk of ASCVD after an unprovoked VTE were determined using Cox proportional hazards models.ResultsDuring median (IQR) 4 (1.5–7) years of follow-up in 31 366 patients with RA, 539 unprovoked VTE and 1648 ASCVD events were identified. The adjusted models showed increased VTE and ASCVD risk with older age, male sex, comorbidities, prior fracture, worse disability, higher disease activity and glucocorticoids. Traditional cardiovascular disease risk factors were common in both ASCVD and VTE but only increased ASCVD risk with obesity as the exception (VTE HR (95% CI), 1.46 (1.13–1.87)) and ASCVD, 0.58 (0.50–0.68)). ASCVD risk doubled after an unprovoked VTE (HR (95% CI), 2.05 (1.43–2.95)).ConclusionOur findings suggest that unprovoked VTE is mediated by inflammation of RA and may be considered a spectrum of pan-cardiovascular syndrome.

Determining the Cardiovascular Disease Risk Factor Knowledge and Related Factors Among Adults With Type 2 Diabetes Mellitus

2021 ◽  
pp. 105477382110464
Author(s):  
Emine Karaman ◽  
Aslı Kalkım ◽  
Banu Pınar Şarer Yürekli
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Related Factors

In this study was to determine knowledge of cardiovascular disease (CVD) risk factors and to explore related factors among adults with type 2 diabetes mellitus (DM) who have not been diagnosed with CVD. This descriptive study was conducted with 175 adults. Data were collected individual identification form and Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale. A negative correlation was found between age and CARRF-KL score. A significant difference was found between educational status and CARRF-KL score. The individuals described their health status as good, managed their condition with diet and exercise, received information from nurses, adults with DM in their family and those with no DM complications had significantly higher scores in CARRF-KL. The knowledge of an individual with DM about CVD risk factors should be assessed, CVD risks should be identified at an early stage, and individuals at risk should be subjected to screening.

scholarly journals Circulating Proangiogenic Cell Activity Is Associated with Cardiovascular Disease Risk

2012 ◽  
Vol 17 (9) ◽  
pp. 1163-1170 ◽  
Author(s):  
Kreton Mavromatis ◽  
Konstantinos Aznaouridis ◽  
Ibhar Al Mheid ◽  
Emir Veledar ◽  
Saurabh Dhawan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Bone Marrow ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cell Activity ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
The Relationship

Vascular injury mobilizes bone marrow–derived proangiogenic cells into the circulation, where these cells can facilitate vascular repair and new vessel formation. We sought to determine the relationship between a new biomarker of circulating bone marrow–derived proangiogenic cell activity, the presence of atherosclerotic cardiovascular disease (CVD) and its risk factors, and clinical outcomes. Circulating proangiogenic cell activity was estimated using a reproducible angiogenic colony-forming unit (CFU-A) assay in 532 clinically stable subjects aged 20 to 90 years and ranging in the CVD risk spectrum from those who are healthy without risk factors to those with active CVD. CFU-A counts increased with the burden of CVD risk factors ( p < 0.001). CFU-A counts were higher in subjects with symptomatic CVD than in those without ( p < 0.001). During follow-up of 232 subjects with CVD, CFU-A counts were higher in those with death, myocardial infarction, or stroke than in those without (110 [70–173] vs 84 [51–136], p = 0.01). Therefore, we conclude that circulating proangiogenic cell activity, as estimated by CFU-A counts, increases with CVD risk factor burden and in the presence of established CVD. Furthermore, higher circulating proangiogenic cell activity is associated with worse clinical outcome in those with CVD.

Abstract 14434: Identification and Predictors for Cardiovascular Disease Risk Equivalents Among Adults With Diabetes Mellitus

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yanglu Zhao ◽  
Shaista Malik ◽  
Matthew J Budoff ◽  
Adolfo Correa ◽  
Kellan E Ashley ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Medication Use ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Hba1c Control ◽  
Event Rates ◽  
Risk Equivalent

Background: It is not well quantified if diabetes mellitus (DM) as a cardiovascular disease (CVD) risk equivalent depends on DM severity and other CVD risk factors. Methods: We pooled 4 US community-based cohorts (ARIC, JHS, MESA, FHS Offspring) and classified subjects by baseline DM/CVD status. DM+/CVD- was further classified by DM duration, HbA1c control or DM medication. Hazard ratios (HR) were estimated for CVD during a median follow-up of 14 years. Subgroup analysis comparing the HR of DM+/CVD- vs. DM-/CVD+ was done by CVD risk factors. We integrated all factors that impacted DM-conferred CVD risk and defined one with DM+/CVD- as CVD risk equivalent when his/her CVD risk was as high or higher than that if he/she had DM-/CVD+. CVD risk profile and event risk were compared between the CVD risk equivalent subgroups in DM+/CVD-. Results: The pooled cohort included 27,732 adults (mean age of 58 years, 45% males). CVD event rates per 1000 P-Y were 16.3, 33.3, 40.9 and 69.0 among those with DM-/CVD-, DM+/CVD-, DM-/CVD+ and DM+/CVD+, respectively. DM participants with HbA1c≥7%, DM duration over 10 years, or DM medication use had similar CVD risk as those with DM-/CVD+ while those without these factors had lower CVD risk; DM+/CVD- had similar CVD risk as those DM-/CVD+ among women, age <55 years, White race, or high triglyceride groups (Figure). Among those with DM+/CVD-, 17.5% were found to be CVD risk equivalents. Compared to those non-CVD risk equivalent DM, they had lower 10-year PCE scores (14.8% vs. 22.7%, p<0.0001) however higher actual CVD event rates (44.9 vs. 31.0 per 1000 P-Y). Conclusion: Among CVD-free adults with DM, fewer than 20% are actually CVD risk equivalents. Poor HbA1c control, long DM duration, and current diabetes medication use were identified as predictors of CVD risk equivalent status and DM was more detrimental for CVD risk if one is female, younger age, White, or with high triglycerides. These risk enhancing factors should be considered in the treatment decision.

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