Effect Of Carotid Ultrasound On The Achievement Of Ldl-Cholesterol Targets In The Routine Clinical Care Of Patients With Rheumatoid Arthritis

Background:Cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is substantially elevated compared to the general population. In RA, as in the general population, CVD control includes the detection and treatment of CV risk factors based, among others, on blood pressure, smoking, diabetes, and lipid profiles. Little is known about the real impact of the use of carotid ultrasound in the prevention of CVD in patients with RA.Objectives:To determine whether the use of carotid ultrasound in the routine clinical care of patients with RA can improve the achievement of LDL-cholesterol targets over time.Methods:We conducted a retrospective, real-world study of 327 RA patients in which a carotid ultrasound was performed as part of routine clinical care. Participants were followed from 2012 to 2018. LDL-c levels were measured before and after the carotid ultrasound intervention. The achievement of the LDL-c goals recommended by the international guidelines was compared before and after the carotid ultrasound. Predictive factors of achievement of LDL-cholesterol targets were studied.Results:When considering the 2010 EULAR RA SCORE risk categories, serum LDL-c levels in the moderate CV risk category was significantly lower when follow-up finished (126 ± 33 to 109 ± 29 mg/dl, p=0.000) (Table 1). This was not the case for other CV risk categories. Similarly, LDL-c goal attainment in the moderate CV risk category was significant higher at the end of the study compared to baseline. Based on the 2016 European Society of Cardiology LDL-c targets, the achievement of a LDL-cholesterol inferior to 115 mg/dl for the moderate CV risk category significantly increased from 35 to 64% (p=0.000) after follow-up. However, significant changes were not observed in this regard for the low, high, and very-high CV risk categories.Table 1.LDL cholesterol serum levels and LDL goals differences between baseline and final follow-upLDL, mg/dlLDL (mg/dl) ESC 2016 goalsn%BaselineFinal follow-upGoalBaselineFinal follow-upp2010 EULAR RA SCORELow12037116 ± 37119 ± 320.081< 13068%66%0.99Moderate19560126 ± 33109 ± 290.000< 11535%64%0.000High72121 ± 26104 ± 220.14< 10014%33%0.99Very High50131 ± 41115 ± 460.080< 700%20%0.99ESC: European Society of Cardiology; EULAR: European League Against Rheumatism. SCORE: Systematic COronary Risk Evaluation; RA: Rheumatoid Arthritis; LDL: low-density lipoprotein. Significant ‘p’ value are depicted in bold.When patients with RA, regardless the SCORE risk they had, were divided between those that attained LDL-cholesterol target or not, those that achieved their LDL goal, were more frequently female and had less diabetes mellitus. Moreover, the probability of achieving LDL-cholesterol goal was higher in those with an inferior total cholesterol, LDL-c and atherogenic index at baseline. Interestingly, no differences were observed in both populations regarding the baseline use of statins, aspirin or hypertension treatment at baseline. Concerning disease related data when study started, no differences about disease duration and activity or treatments were observed between dose that reached LDL-cholesterol goal and those that did not.Those that achieved LDL-c objectives had a higher decrease in smoking quit and a superior control of hypertension. Besides, in those that attained objectives a superior increase in statins prescription was observed (36% vs. 13%, p=0.000), as well in hypertension and aspirin treatment. However, no differences were noticed in the changes in disease-related data that occur during the time the study was carried out.Conclusion:This real-world study demonstrates that incorporating carotid ultrasound into routine clinical practice in RA patients is effective in achieving LDL-cholesterol targets for the prevention of cardiovascular disease. This effect is not only mediated by the increase in the prescription of statins, but also by the better control of other cardiovascular risk factors that occurred after carotid ultrasound evaluation.Disclosure of Interests:None declared