Atherosclerotic Cardiovascular Risk Assessment and associated factors among patients with Rheumatoid Arthritis at Tikur Anbessa Specialized Hospital Rheumatology referral clinic: Cross sectional study design
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Date
2024-03
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Addis Ababa University
Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) is the major cause of mortality in
patients with Rheumatoid Arthritis (RA), due to the higher prevalence of conventional risk
factors and other novel risk factors. This has been shown in the literature and the guidelines
recommend a routine CV screening for all RA patients. Despite this, there is no formal
cardiovascular risk assessment practice for our patients with Rheumatoid Arthritis and no studies
have been published yet in Ethiopia and Africa that assessed the 10 year ASCVD risk score in
this patient group.
Objectives: This study aimed to assess the ASCVD risk score among patients with RA on
follow-up at the Rheumatology clinic of Tikur Anbessa Specialized Hospital, to correlate among
AHA/PCE, WHO lab and non-laboratory CV risk assessment tools, to determine CV risk factors
and assess statin use in high risk patients.
Methods: A single center cross-sectional study was conducted from September 1 to November
30, 2023 GC at the Rheumatology Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa.
A total of 180 patients were enrolled in the study and Data was collected through structured
questionnaires using a standard WHO STEPs instrument for non-communicable Disease
surveillance with some modifications. The updated 2019 WHO CVD risk charts and AHA/ACC
PCE ASCVD plus score (2018) risk calculators were used to calculate the 10 year CVD risk
score. Binary logistic regression was used to assess the association between high 10-year CVD
risk and associated factors, with a p-value of <0.05 considered statistically significant
Results: The magnitude of high 10 year ASCVD risk score in RA patients was found to be 17.6%
using the WHO non laboratory CV risk assessment tool which identified the higher proportion of
high risk patients followed by AHA/PCE and WHO laboratory risk assessment tools which
accounted for 8.3% and 2.8% respectively. Despite this discrepancy, there was a significant
positive correlation among the three CV risk calculators with r (178) = .887 between WHO
laboratory and non-laboratory CV risk tools, .863 between the WHO-non-laboratory and
AHA/PCE risk tools and .915 among the WHO laboratory and AHA/PCE risk tools.
Hypertension and age were found to be the main drivers of high 10 year ASCVD risk score and
only 25% of the high risk groups were on statins. Dyslipidemia was the commonest CV risk
factor identified followed by Hypertension and Diabetes Mellitus.
Conclusion and recommendations: The magnitude of elevated 10 year ASCVD score is high
among RA patients in Ethiopia which is demonstrated by the prevalent traditional CV risk factors.
Despite this, Statin utilization among high risk patients is poor. We recommend a larger prospective
observational study to identify RA specific variables and their association with cardiovascular
disease. Primary care physicians and Internists have to practice routine ASCVD risk assessment for
all patients with Rheumatoid Arthritis as per the guidelines. The WHO non-laboratory CV risk
assessment chart can be a suitable tool in a resource limited setting like ours. Additionally, statins
have to be administered for RA patients with intermediate and high CV risk.
Description
Keywords
ASCVD, Cardiovascular risk, Risk assessment, Rheumatoid Arthritis, Rheumatology clinic.