Screening for cardiovascular disease in Rheumatoid Arthritis: a records-based investigation

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease affecting approximately 1% of the population. The life expectancy of those with RA is reduced, mainly due to an increased risk of cardiovascular disease (CVD). This thesis investigates whether this increased CVD risk is recognised and translated into screening for these patients in primary care. First, a systematic literature review examined cardiovascular screening for patients with RA. Ten studies were identified. All included screening for serum lipids, six included blood pressure and three included blood glucose, smoking status and body mass index (BMI)/body weight. Variability in screening practice was identified between the included studies. Second, 401 RA patients and 1198 age, gender and practice matched non-RA patients were identified from a primary care database (CiPCA). CiPCA was searched for evidence of screening for five traditional cardiovascular risk factors: blood pressure, body weight/BMI, smoking status, glucose levels and lipid status. No difference in levels of screening for individual risk factors between RA and non-RA patients were identified, apart from smoking status, which was more likely to be recorded in RA patients, 62% versus 67% (percentage difference 5%: 95%CI 0.0%, 10.0%). Screening for ≥1 cardiovascular risk factors was more common in RA patients, 88% versus 82% (5.8%: 1.4%, 9.2%). However, RA patients were not more likely to receive a standard CVD screen (screening of blood pressure, lipids and smoking status) (OR 0.95 (95% CI 0.70, 1.28)) or a comprehensive CVD screen (all five risk factors) (OR 0.84 (95% CI 0.61, 1.16)) when compared to non-RA patients. These results suggest that the increased risk of CVD in RA has not been recognised and translated into screening in primary care. More emphasis needs to be focussed on identifying and aggressively treating CVD risk factors in this group