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Rheumatology (Oxford). 2017 Feb 10. doi: 10.1093/rheumatology/kew497. [Epub ahead of print]

Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the Implementation of Cardiovascular Risk Management in Rheumatoid Arthritis project.

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Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam.
Department of Rheumatology, Antonius Hospital Zuidwest Friesland, Sneek.
Department of General Practice and Geriatric Medicine, VU University Medical Center, Amsterdam.
Dutch Institute for Rational Use of Medicine, Utrecht.
Department of Internal Medicine.
Department of Rheumatology VU University Medical Center.
Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, AMC, Amsterdam, The Netherlands.



To assess the 10-year cardiovascular (CV) risk score and to identify treatment and undertreatment of CV risk factors in patients with established RA.


Demographics, CV risk factors and prevalence of cardiovascular disease (CVD) were assessed by questionnaire. To calculate the 10-year CV risk score according to the Dutch CV risk management guideline, systolic blood pressure was measured and cholesterol levels were determined from fasting blood samples. Patients were categorized into four groups: indication for treatment but not treated; inadequately treated, so not meeting goals (systolic blood pressure ⩽140 mmHg and/or low-density lipoprotein ⩽2.5 mmol/l); adequately treated; or no treatment necessary.


A total of 720 consecutive RA patients were included, 375 from Reade and 345 from the Antonius Hospital. The mean age of patients was 59 years ( s . d . 12) and 73% were female. Seventeen per cent of the patients had a low 10-year CV risk (<10%), 21% had an intermediate risk (10-19%), 53% a high risk (⩾20%) and 9% had CVD. In total, 69% had an indication for preventive treatment (cholesterol-lowering or antihypertensive drugs). Of those, 42% received inadequate treatment and 40% received no treatment at all.


Optimal CV risk management remains a major challenge and better awareness and management are urgently needed to reduce the high risk of CVD in the RA population.


cardiovascular disease; cardiovascular risk management; rheumatoid arthritis

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