title: Challenges of cardiovascular risk assessment in the routine rheumatology outpatient setting: an observational study of 110 rheumatoid arthritis patients.
abstract: OBJECTIVE
  An annual assessment of cardiovascular (CV) risk factors in rheumatoid arthritis (RA) is recommended, but its practical modalities have not been determined. The objective was to assess the feasibility and usefulness of a standardized CV risk assessment in RA, performed by rheumatologists during outpatient clinics.
  
  
  METHODS
  We used a cross-sectional design within a network of rheumatologists. Each rheumatologist included 5 consecutive unselected patients with definite RA. Data collection included standardized assessment of CV risk factors: blood pressure, interpretation of glycemia and of lipid levels, and calculation of the Framingham CV risk score. Outcome criteria included feasibility (missing data and time taken to assess the patients) and usefulness (the CV risk assessment was considered useful if at least 1 modifiable and previously unknown CV risk factor was evidenced).
  
  
  RESULTS
  Twenty-two rheumatologists (77% in office-based practice) assessed 110 RA patients. The mean ± SD age was 57 ± 10 years, and the mean ± SD RA duration was 11 ± 9 years; 50 patients (45%) were treated with biologic agents, and 76% were women. Regarding feasibility, missing data were most frequent for glycemia (27% of patients) and cholesterolemia (14% of patients). The mean ± SD duration of the CV risk assessment was 15 ± 5 minutes. The CV risk assessment was considered useful in 33 patients (30%), evidencing dyslipidemia (15% of patients) or high blood pressure (9% of patients) as the most frequently previously unknown CV risk factor.
  
  
  CONCLUSIONS
  The assessment of CV risk factors is feasible, but labor intensive, during an outpatient rheumatology clinic. This assessment identified modifiable CV risk factors in 30% of the patients. These results suggest that RA patients are not sufficiently assessed and treated for CV risk factors.
authors.affiliation: Paris-Descartes University and AP-HP, Cochin Hospital, Paris, France. laure.gossec@psl.aphp.fr
authors.forename: L
authors.initials: L
authors.lastname: Gossec
authors.forename: F
authors.initials: F
authors.lastname: Salejan
authors.forename: H
authors.initials: H
authors.lastname: Nataf
authors.forename: M
authors.initials: M
authors.lastname: Nguyen
authors.forename: V
authors.initials: V
authors.lastname: Gaud-Listrat
authors.forename: C
authors.initials: C
authors.lastname: Hudry
authors.forename: P
authors.initials: P
authors.lastname: Breuillard
authors.forename: E
authors.initials: E
authors.lastname: Dernis
authors.forename: P
authors.initials: P
authors.lastname: Boumier
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authors.lastname: Durandin-Truffinet
authors.forename: J
authors.initials: J
authors.lastname: Fannius
authors.forename: J
authors.initials: J
authors.lastname: Fechtenbaum
authors.forename: M-A
authors.initials: MA
authors.lastname: Izou-Fouillot
authors.forename: S
authors.initials: S
authors.lastname: Labatide-Alanore
authors.forename: A
authors.initials: A
authors.lastname: Lebrun
authors.forename: P
authors.initials: P
authors.lastname: LeDevic
authors.forename: P
authors.initials: P
authors.lastname: LeGoux
authors.forename: A
authors.initials: A
authors.lastname: Sacchi
authors.forename: C
authors.initials: C
authors.lastname: Salliot
authors.forename: L
authors.initials: L
authors.lastname: Sparsa
authors.forename: F Lecoq
authors.initials: FL
authors.lastname: d'André
authors.forename: M
authors.initials: M
authors.lastname: Dougados
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012219:Rheumatology / Q000379:methods; D018570:Risk Assessment