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Management of hyperlipidemia among patients with rheumatoid arthritis in the primary care setting.

Jafri K, Taylor L, Nezamzadeh M, Baker JF, Mehta NN, Bartels C, Williams CT, Ogdie A - BMC Musculoskelet Disord (2015)

Bottom Line: Factors associated with not receiving lipid screening were examined using logistic regression models.Among 1,056 patients with RA followed by PCPs and eligible for lipid screening, lipid screening was ordered for 539 (51%) within the 3-year follow-up period.Patients with diabetes, hypertension, chronic kidney disease, obesity or age >50 were more likely to be screened.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Kashif.jafri@uphs.upenn.edu.

ABSTRACT

Background: Rheumatoid arthritis (RA) has been associated with an increased risk of cardiovascular morbidity and mortality but this has not translated to optimal management of traditional cardiovascular risk factors such as hyperlipidemia. The objectives of this study were to 1) determine the prevalence of screening for hyperlipidemia in patients with RA followed by primary care practitioners (PCP); 2) examine initiation of lipid-lowering therapy in patients with an indication, and 3) assess whether proposed modifications to cardiovascular risk calculations change the percentage of RA patients with an indication for therapy.

Methods: We performed a retrospective cohort study using an academic medical center-based medical record database in the United States. Patients with RA defined by the presence of at least one ICD-9 code between 2005-2010 and followed by a PCP within the health care system were included. The positive predictive value of ICD-9 codes for accurately identifying patients with RA was 96.7%. Descriptive statistics were used to report the prevalence of screening and use of lipid-lowering therapy among those with an indication. Factors associated with not receiving lipid screening were examined using logistic regression models. Indication for and receipt of therapy were then assessed before and after the application of the European Union League Against Rheumatism (EULAR) recommended multiplier to the Framingham risk score.

Results: Among 1,056 patients with RA followed by PCPs and eligible for lipid screening, lipid screening was ordered for 539 (51%) within the 3-year follow-up period. Patients with diabetes, hypertension, chronic kidney disease, obesity or age >50 were more likely to be screened. Of those with lipid results (N = 290), 25 (9%) patients had an indication for lipid-lowering therapy based on Adult Treatment Panel III guidelines. Ten (40%) patients with an indication for lipid-lowering therapy received therapy did not receive therapy. Applying the EULAR multiplier only changed the indication for lipid-lowering therapy in two patients.

Conclusions: Screening and management of traditional cardiovascular risk factors, including hyperlipidemia, need to be optimized.

No MeSH data available.


Related in: MedlinePlus

Flow Diagram. Among 1418 patients with rheumatoid arthritis followed by a primary care physician, 1056 were eligible for screening and 539 received screening. Among those with orders for lipids, 290 had complete lipid panels for analysis after excluding those with contraindications to therapy. *Contraindications to therapy included pregnancy (N = 5), myopathy (N = 2), liver disease (e.g. cirrhosis, liver cancer, alcoholic liver disease, hepatitis C, hepatitis B) (N = 16) or interacting medications including erythromycin, protease inhibitors, itraconazole, and clarithromycin (N = 8). Abbreviations: RA = rheumatoid arthritis, LDL = low density lipoprotein, LLT = lipid lowering therapy
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Fig1: Flow Diagram. Among 1418 patients with rheumatoid arthritis followed by a primary care physician, 1056 were eligible for screening and 539 received screening. Among those with orders for lipids, 290 had complete lipid panels for analysis after excluding those with contraindications to therapy. *Contraindications to therapy included pregnancy (N = 5), myopathy (N = 2), liver disease (e.g. cirrhosis, liver cancer, alcoholic liver disease, hepatitis C, hepatitis B) (N = 16) or interacting medications including erythromycin, protease inhibitors, itraconazole, and clarithromycin (N = 8). Abbreviations: RA = rheumatoid arthritis, LDL = low density lipoprotein, LLT = lipid lowering therapy

Mentions: Among patients in whom lipid testing was recommended (N = 593), 290 patients had available lipid results after excluding patients with a contraindication to lipid-lowering therapy (N = 30), and those without sufficient data to calculate a Framingham risk score (N = 1) (Fig. 1). Most patients (65 %) were in the lowest risk category (0–1 cardiovascular risk factors), and 32 % of patients were in the highest risk group with a 10-year cardiovascular risk greater than 20 %. Very few patients (3 %) had 2 or more cardiovascular risk factors with a 10-year cardiovascular risk less than 20 %. Among the 290 patients with complete data, the mean total cholesterol was 190.2 mg/dl (SD 42.2), the mean LDL was 109.4 mg/dl (SD 32.4), and the mean HDL was 58.2 mg/dl (SD 20.3). Mean age at the time of the lipid panel was 61.4 years (SD 13.5).Fig. 1


Management of hyperlipidemia among patients with rheumatoid arthritis in the primary care setting.

Jafri K, Taylor L, Nezamzadeh M, Baker JF, Mehta NN, Bartels C, Williams CT, Ogdie A - BMC Musculoskelet Disord (2015)

Flow Diagram. Among 1418 patients with rheumatoid arthritis followed by a primary care physician, 1056 were eligible for screening and 539 received screening. Among those with orders for lipids, 290 had complete lipid panels for analysis after excluding those with contraindications to therapy. *Contraindications to therapy included pregnancy (N = 5), myopathy (N = 2), liver disease (e.g. cirrhosis, liver cancer, alcoholic liver disease, hepatitis C, hepatitis B) (N = 16) or interacting medications including erythromycin, protease inhibitors, itraconazole, and clarithromycin (N = 8). Abbreviations: RA = rheumatoid arthritis, LDL = low density lipoprotein, LLT = lipid lowering therapy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4559905&req=5

Fig1: Flow Diagram. Among 1418 patients with rheumatoid arthritis followed by a primary care physician, 1056 were eligible for screening and 539 received screening. Among those with orders for lipids, 290 had complete lipid panels for analysis after excluding those with contraindications to therapy. *Contraindications to therapy included pregnancy (N = 5), myopathy (N = 2), liver disease (e.g. cirrhosis, liver cancer, alcoholic liver disease, hepatitis C, hepatitis B) (N = 16) or interacting medications including erythromycin, protease inhibitors, itraconazole, and clarithromycin (N = 8). Abbreviations: RA = rheumatoid arthritis, LDL = low density lipoprotein, LLT = lipid lowering therapy
Mentions: Among patients in whom lipid testing was recommended (N = 593), 290 patients had available lipid results after excluding patients with a contraindication to lipid-lowering therapy (N = 30), and those without sufficient data to calculate a Framingham risk score (N = 1) (Fig. 1). Most patients (65 %) were in the lowest risk category (0–1 cardiovascular risk factors), and 32 % of patients were in the highest risk group with a 10-year cardiovascular risk greater than 20 %. Very few patients (3 %) had 2 or more cardiovascular risk factors with a 10-year cardiovascular risk less than 20 %. Among the 290 patients with complete data, the mean total cholesterol was 190.2 mg/dl (SD 42.2), the mean LDL was 109.4 mg/dl (SD 32.4), and the mean HDL was 58.2 mg/dl (SD 20.3). Mean age at the time of the lipid panel was 61.4 years (SD 13.5).Fig. 1

Bottom Line: Factors associated with not receiving lipid screening were examined using logistic regression models.Among 1,056 patients with RA followed by PCPs and eligible for lipid screening, lipid screening was ordered for 539 (51%) within the 3-year follow-up period.Patients with diabetes, hypertension, chronic kidney disease, obesity or age >50 were more likely to be screened.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Kashif.jafri@uphs.upenn.edu.

ABSTRACT

Background: Rheumatoid arthritis (RA) has been associated with an increased risk of cardiovascular morbidity and mortality but this has not translated to optimal management of traditional cardiovascular risk factors such as hyperlipidemia. The objectives of this study were to 1) determine the prevalence of screening for hyperlipidemia in patients with RA followed by primary care practitioners (PCP); 2) examine initiation of lipid-lowering therapy in patients with an indication, and 3) assess whether proposed modifications to cardiovascular risk calculations change the percentage of RA patients with an indication for therapy.

Methods: We performed a retrospective cohort study using an academic medical center-based medical record database in the United States. Patients with RA defined by the presence of at least one ICD-9 code between 2005-2010 and followed by a PCP within the health care system were included. The positive predictive value of ICD-9 codes for accurately identifying patients with RA was 96.7%. Descriptive statistics were used to report the prevalence of screening and use of lipid-lowering therapy among those with an indication. Factors associated with not receiving lipid screening were examined using logistic regression models. Indication for and receipt of therapy were then assessed before and after the application of the European Union League Against Rheumatism (EULAR) recommended multiplier to the Framingham risk score.

Results: Among 1,056 patients with RA followed by PCPs and eligible for lipid screening, lipid screening was ordered for 539 (51%) within the 3-year follow-up period. Patients with diabetes, hypertension, chronic kidney disease, obesity or age >50 were more likely to be screened. Of those with lipid results (N = 290), 25 (9%) patients had an indication for lipid-lowering therapy based on Adult Treatment Panel III guidelines. Ten (40%) patients with an indication for lipid-lowering therapy received therapy did not receive therapy. Applying the EULAR multiplier only changed the indication for lipid-lowering therapy in two patients.

Conclusions: Screening and management of traditional cardiovascular risk factors, including hyperlipidemia, need to be optimized.

No MeSH data available.


Related in: MedlinePlus