Ischaemic heart disease in rheumatoid arthritis patients

S. Saravana and T. Gillott

Department of Rheumatology, Diana Princess of Wales Hospital, Grimsby, UK

Correspondence to: S. Saravana. E-mail: adersh555saravana{at}hotmail.com

SIR, We read with an interest the recent editorial by Kitas and Erb [1]. Patients with rheumatoid arthritis (RA) have a reduced life expectancy when compared with the general population. Recent studies showed that cardiovascular death is considered to be the leading cause of mortality in patients with RA [2]. It is thought to be due to accelerated atherosclerosis via persistent inflammation. Wallberg-Jonsson et al. [3] examined cardiovascular morbidity and mortality in a cohort of seropositive RA patients. They found that 34% of their cohort had a cardiovascular event during 15 yr of follow-up. Del Rincon et al. [4] showed that the incidence of cardiovascular events in RA was 3.43/100 patient-years vs 0.59/100 patient-years in controls. Risk factors for cardiovascular events are not properly addressed in our busy rheumatology out-patient clinics. So we did a small study to check traditional cardiovascular risk factors in RA patients in out-patient clinics. We recruited 98 successive patients from our rheumatology out-patient clinics. We gave particular importance to the fasting lipid profile and body mass index.

Twelve out of 98 patients (12.24%) had a personal history of ischaemic heart disease (IHD). Most of the patients were taking aspirin and anti-anginal medications. The lipid profile was analysed in the fasting blood sample. The mean cholesterol level was 5.3 mmol in patients with a history of IHD and 5.6 mmol in other patients. Forty-nine patients had a mean cholesterol/high-density lipoprotein (HDL) ratio of more than 4.44 mmol (upper limit of normal is 4.44 mmol), including five patients with IHD. Thirty-five patients with a cholesterol/HDL ratio of more than 4.44 were not taking statins, including two patients with a history of IHD. It is interesting to note that the mean body mass index (BMI) was 27.96, and 56 patients had a BMI of more than 25. Lipids and hypertension may relate to obesity and a sedentary lifestyle. These factors are now considered as major ischaemic risk factors.

Significant proportions of our patients with a high cholesterol/HDL ratio were not taking statins, and these included five patients with IHD. More than 50% of patients had a high BMI (>25). It is debatable whether we should counsel all RA patients regarding cardiovascular risk factors and check their fasting lipids and glucose. It may be impossible to assess the risk factors in busy rheumatological out-patient clinics, but we could advise general practitioners to do this. There are no data available suggesting the threshold value for treating dyslipidaemia in RA patients. While hypertension and diabetes are commonly identified and treated, dyslipidaemia is frequently forgotten as an important risk factor. So the question unanswered is whether we should have a lower threshold for treating dyslipidaemia in RA patients.

The authors have declared no conflicts of interest.

References

  1. Kitas GD, Erb N. Tackling ischaemic heart disease in rheumatoid arthritis. Rheumatology May 2003;42:607–13.[CrossRef]
  2. Goodson N. Coronary artery disease and rheumatoid arthritis. Curr Opin Rheumatol 2002;14:115–20.[CrossRef][ISI][Medline]
  3. Wallberg-Jonsson S, Johansson H, Rantappa-Dahlqvist S. Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset. J Rheumatol 1999;26:2562–71.[ISI][Medline]
  4. Del Rincon I, Williams K, Stern M et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by cardiovascular risk. Arthritis Rheum 2000;43:S152.
Accepted 12 June 2003