Trial results support management of cardiovascular risk factors in RA patients
medwireNews: Managing traditional cardiovascular (CV) risk factors with a treat-to-target approach slows progression of subclinical atherosclerosis among patients with rheumatoid arthritis (RA), suggest results from the FRANCIS trial.
RA patients have an elevated CV disease (CVD) risk, attributed partly to an increased prevalence of traditional CV risk factors compared with the general population, but these risk factors – including hypercholesterolemia, hypertension, and obesity – “are underdiagnosed and undertreated in patients with RA,” say Benjamin Burggraaf (Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands) and colleagues.
The study included 320 patients aged 70 years or younger with an estimated 10-year risk for fatal CVD below 10% (as measured by the 2006 unadjusted Systematic Coronary Risk Evaluation assessment), all of whom attended clinic visits twice a year for measurement of CV risk factors and subclinical atherosclerosis.
Participants were randomly assigned to receive the treat-to-target intervention – involving initiation of antihypertensive treatment, lipid-lowering drugs, antidiabetic agents, and dietary/lifestyle advice as needed according to a protocol with specific targets for each CV risk factor – or to receive usual care based on physicians’ judgement.
At the 5-year follow-up, a significantly higher proportion of patients in the treat-to-target compared with the control group achieved target low-density lipoprotein (LDL) cholesterol levels (<3.0 mmol/L), at 75.6% versus 48.6%. However, there was no significant difference between the groups in the proportion of patients meeting glycated hemoglobin and systolic blood pressure targets (<48 mmol/mol and <140 mmHg, respectively).
The FRANCIS (Franciscus Rheumatoid Arthritis and Cardiovascular Intervention Study) investigators report that progression of subclinical atherosclerosis, measured by increase in carotid intima media thickness over 5 years, was significantly lower among participants in the intervention compared with the control group, with averages of 0.023 versus 0.045 mm.
This was accompanied by a significantly lower rate of first CV events in the treat-to-target group (1.3 vs 4.7%), but the study authors note that these findings were based on “a small number of clinical events” (two and seven, respectively), and therefore “need to be confirmed in larger trials.”
They also caution that because the trial only included low-risk patients, “the CVD risk found in our study may underestimate the CVD risk in a general RA cohort,” and note that the drop-out rate was “considerable,” with only 68.4% of the 320 patients initially randomized remaining in the study at the 5-year follow-up.
Nevertheless, they conclude in the Annals of the Rheumatic Diseases: “These findings provide for the first time evidence on the efficacy of cardiovascular risk management in patients with rheumatoid arthritis.”
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