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CVD risk in RA patients neglected

GPs 'grossly underprescribe' antihypertensives and lipid-lowering drugs to patients with rheumatoid arthritis despite their high cardiovascular risk, two new studies reveal.

Patients with rheumatoid arthritis have standardised mortality ratios two to three times those of the general population and half the excess mortality is attributable to cardiovascular events, researchers told the British Society for Rheumatology annual conference.

Their studies, presented at the conference in Manchester this month, showed arthritis patients with a high risk of cardiovascular disease were missing out on primary and secondary prevention recomm- ended in the national service framework for coronary heart disease.

The framework states patients with a 10-year risk of a CHD event over 30 per cent should be given treatment to reduce blood pressure below 140/85mmHg and statins to reduce total cholesterol to less than 5mmol/l.

Patients with diagnosed heart disease should also be on low-dose aspirin and considered for an ACE inhibitor.

A prospective trial of 80 rheumatology outpatients in Oxfordshire by the Nuffield Orthopaedic Centre in Oxford found of the 10 patients in the group with high cholesterol ­ between 6.7 and 9.0mmol/l ­ only nine were on any treatment. Only three were on aspirin and/or an ACE inhibitor.

The second study benchmarked prescribing for secondary prevention of cardiovascular disease against framework targets for blood pressure and lipid levels in 60 rheumatology outpatients at North Manchester General Hospital.

Some 15 per cent of the study group (nine patients) had a history of cardiovascular disease, but none were receiving secondary preventive drugs, the study found.

Eight of the nine patients had total cholesterol levels above 5mmol/l, but only one was on lipid-lowering therapy. Four also had a blood pressure level above 140/85mmHg but none were receiving antihypertensive therapy.

Study co-author Dr Beverley Harrison, consultant rheu-matologist at the hospital, said the cardiovascular risk in ar-thritis patients often went untreated because they reported fewer exertion-related symptoms.

Dr Graham Davenport, president of the Primary Care Rheumatology Society and a GP in Wrenbury, Cheshire, agreed: 'Doctors are so busy in primary care dealing with the rheumatoid problems they forget the cholesterol side.'

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