Alice Goodman

June 06, 2011

June 6, 2011 (London, United Kingdom) — After experiencing a first myocardial infarction (MI), patients with rheumatoid arthritis (RA) were much less likely to have been prescribed standard post-MI treatments, including aspirin, statins, and beta blockers, than were healthy control patients, according to a very large study based on a Danish National Registry of patients with a first MI between 2002 and 2009, presented here at the European League Against Rheumatism (EULAR) Congress 2011.

"We know that RA patients are at about a 50% increased risk of cardiovascular disease. Our study suggests that cardiovascular disease may be undertreated in these patients," said Jesper Lindharsen, MD, from the Gentofte University Hospital in Copenhagen, Denmark. He suggested that reasons for undertreatment might include physicians' reluctance to prescribe additional medications to patients with RA on active treatment and/or patient adherence.

Although the study did not look at actual prescriptions, only initiation of treatment, "people given prescriptions are more likely to buy the drug and initiate treatment. It is estimated that 95% of people do buy a prescribed drug. The study suggests that these patients did not get the prescriptions for the cardioprotective drugs post-MI."

The study was based on 66,389 survivors of a first MI; 875 (1.3%) also had a diagnosis of RA. At baseline, average age was about 70 years, 63% were men, and 37% were women; among patients with RA, at baseline, about 25% were taking aspirin, 20% a statin, 23% a beta blocker, and 3% clopidogrel. The percentages of healthy control patients taking these drugs were similar at baseline.

At 30 days, patients with RA were 32% less likely to get a statin, 24% less likely to initiate therapy with a beta blocker, and 25% less likely to initiate aspirin therapy compared with healthy control patients. These findings were unchanged at 180 days. A similar percentage of patients with RA and control patients were taking clopidogrel at 30 and 180 days, which is usually prescribed by an invasive cardiologist, Dr. Lindharsen said.

Further research is needed to identify the reasons for the undertreatment of patients with RA. Dr. Lindharsen said that other studies have suggested that patients with RA who are at increased risk for cardiovascular disease, but have not suffered an MI, are undertreated as well.

According to EULAR's Chair of the Scientific Program Committee Georg Schett, MD, this study could reflect a selection bias, because at baseline, more patients with RA should have been receiving cardioprotective drugs that include aspirin, antihypertension agents, and lipid-lowering agents, but only a small percentage were taking these drugs. "This might have selected for poor compliance," he noted.

Primary care physicians should be paying more attention to cardiovascular risk factors in patients with RA, who are at increased cardiovascular risk, and prescribing appropriate drugs and making sure patients are taking them, Dr. Schett said.

Dr. Lindharsen and Dr. Schett have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2011: Abstract OP0283. Presented May 27, 2011.

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