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Objectives: Inflammatory joint disease (IJD) is associated with an increased risk of developing cardiovascular disease (CVD). Arterial stiffness is both a risk factor and a surrogate marker for CVD. This study aims to compare arterial stiffness across patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, and, by extension, to explore the relationship between arterial stiffness and the estimated CVD risk by the Systematic COronary Risk Evaluation (SCORE) algorithm. Method: During the study period, from April 2017 to June 2018, 196 patients with IJD visited the Preventive Cardio-Rheuma Clinic in Oslo, Norway. A CVD risk stratification was performed, including the assessment of traditional risk factors and the measurement of arterial stiffness. Results: Thirty-six patients (18.4%) had elevated aortic pulse wave velocity (aPWV) (≥ 10 m/s). After adjustment for age and heart rate, arterial stiffness was comparable across the IJD entities (p = 0.69). Associated factors, revealed by regression analysis, were age, blood pressure, heart rate, presence of carotid plaques, establis hed CVD, non-steroidal anti-inflammatory drugs, and statin use. Furthermore, aPWV was positively correlated with estimated CVD risk (r = 0.7, p < 0.001) and patients with a very high predicted CVD risk (SCORE ≥ 10%) had significantly higher aPWV than patients at lower CVD risk (9.2 vs 7.5 m/s, p < 0.001). Conclusion: The degree of arterial stiffness was comparable across the IJD entities and was highly associated with the estimated CVD risk. Our findings support the need for an increased focus on prevention of CVD in all patients with IJD.

Aims To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions and to evaluate the management and goal attainment of lipids and blood pressure (BP). Methods and results The survey of CVD risk factors in patients with RA was conducted in 14 503 patients from 19 countries during 2014–19. The treatment goal for BP was Conclusion We revealed considerable geographical differences in estimated CVD risk and preventive treatment. Low goal attainment for LLT was observed, and only half the patients obtained BP goal. Despite a high focus on the increased CVD risk in RA patients over the last decade, there is still substantial potential for improvement in CVD preventive measures.

Patients with rheumatoid arthritis (RA) are at high risk of developing cardiovascular disease (CVD). Inflammation has a pivotal role in the pathogenesis of CVD. RA is an inflammatory joint disease and, compared with the general population, patients with RA have approximately double the risk of atherosclerotic CVD, stroke, heart failure and atrial fibrillation. Although this high risk of CVD has been known for decades, patients with RA receive poorer primary and secondary CVD preventive care than other high-risk patients, and an unmet need exists for improved CVD preventive measures for patients with RA. This Review summarizes the evidence for atherosclerotic CVD in patients with RA and provides a contemporary analysis of what is known and what needs to be further clarified about recommendations for CVD prevention in patients with RA compared with the general population. The management of traditional CVD risk factors, including blood pressure, lipids, diabetes mellitus and lifestyle-related risk factors, as well as the effects of inflammation and the use of antirheumatic medication on CVD risk and risk management in patients with RA are discussed. The main aim is to provide a roadmap of atherosclerotic CVD risk management and prevention for patients with RA. Atherosclerotic cardiovascular disease is a major cause of morbidity and mortality in patients with rheumatoid arthritis. In this Review, Semb and colleagues outline atherosclerotic cardiovascular disease risk management and prevention for patients with rheumatoid arthritis.

Background The cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is comparable to that of patients with diabetes mellitus (DM). Although several studies have indicated high prevalence's of DM in RA patients, little is known about how this affects their CVD risk. Objectives To examine indications for, and use of antihypertensive treatment (a-HT) and lipid-lowering therapy (LLT) in RA patients with DM (RA-DM) and RA patients without DM (RAwoDM). Further, to compare the prevalence of various types of CVD across RA-DM and RAwoDM. Methods The cohort was derived from the SUrvey of cardiovascular disease Risk Factor in patients with Rheumatoid Arthritis (SURF-RA), which was performed in 53 centres/17 countries in 5 world regions (West and East Europe; North and Latin America; and Asia) from 2014 - 2019. Indication for a-HT was defined as: 1) systolic/diastolic blood pressure (BP) ≥140/90 mm Hg, 2) self-reported hypertension, and/or 3) current use of a-HT. Indication for LLT was defined according to ESC guidelines. CVD risk estimates (by SCORE) were multiplied by 1.5 according to EULAR recommendations. Target treatment targets for BP and lipids were defined according to ESC guidelines applicable at the time data were recorded. Results Presence of comorbid DM was available in 10 602 (73.1%) of the 14 503 RA patients included in SURF-RA, of whom 75 and 1262 patients reported DM type 1 and type 2, respectively (total 1337 patients, 12.6%). Although less often current smokers, RA-DM patients were more often previous smokers, male sex and had higher body mass index compared to RAwoDM (p Conclusion The effect of RA and comorbid DM on CVD risk appears to be additive. While CVD preventive medications are more often indicated in RA-DM than in RAwoDM patients, they are also more likely to receive such therapy and to reach CVD preventive treatment goals. The latter finding may be due to more developed CVD preventive care in DM compared to RA patients. Improved CVD preventive systems for patients with RA are warranted. CVD in RA patients with and without DM Funding Acknowledgement Type of funding source: Other. Main funding source(s): Lilly

Background/Introduction The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. Purpose To describe differences in lipid and blood pressure (BP) levels among patients with RA from five world regions. Furthermore, to evaluate attainment of guideline recommended targets for lipid lowering and antihypertensive treatment. Methods The SUrvey of CVD Risk Factors in patients with RA (SURF-RA) was conducted at 53 centres in 19 countries from 2014 to 2019. Data including demographics, RA disease characteristics, CVD comorbidity, risk factors and use of preventive treatment was collected. HT was defined as self-reported HT, and/or measured BP >140/90 mmHg, and/or use of anti HT medication (a-HT). The treatment goal of a-HT was BP Results In total, 14503 RA patients were included. The mean age was 59.8±13.6 years, most of whom (74%) were female. Nearly 2/3 of the patients were hypertensive. Use of a-HT in the total population differed substantially between the cohorts with limited use in West Europe and Latin America (17.4% and 24.8%), in contrast to North America and East Europe (46.8% and 57.0%). On average, half of those with HT were at the recommended BP goal. The lowest BP goal attainment was seen in Asia, West and East Europe (40.8–43.1%), and the highest in North America (63.5%). Overall 51.5% had an indication for lipid lowering therapy (LLT), and of these only 43.5% were taking LLT. Only 34.0% of patients with an indication for LLT were at recommended LDL-c goals. The proportion of RA patients on target for LDL-c varied greatly between regions, from 23.1% in East Europe to 51.0% in North America. The LDL-c goal attainment was higher in RA patients at high risk (45.1%) compared to those at very high risk of CVD (18.0%). Conclusion(s) This large international survey on RA patients revealed considerable geographical differences in CVD preventive treatment. Only one half of subjects were at blood pressure goals, and achievement of lipid goals was even poorer at one third of those eligible for treatment, which is lower than what is reported for subjects with coronary heart disease. We conclude that there is a substantial need for improvement in CVD preventive measures in RA patients. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted research collaboration with Lilly

Background In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics. Methods RA patients aged 30–70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up. Results A total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15–32% of patients. C-statistics ranged 0.68–0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results. Conclusions The cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.

Objectives Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status. Results Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5–6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P Conclusion Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.

Objective Statin treatment has been associated with reduction in blood pressure and arterial stiffness in patients with inflammatory joint diseases (IJD). We tested whether statin treatment also was associated with regression of preclinical cardiac organ damage in IJD patients. Methods Echocardiography was performed in 84 IJD patients (52 RA, 20 ankylosing spondylitis, 12 psoriatric arthritis, mean age 61 (9) years, 63% women) without known cardiovascular disease before and after 18 months of rosuvastatin treatment. Preclinical cardiac organ damage was identified by echocardiography as presence of left ventricular (LV) hypertrophy, LV concentric geometry, increased LV chamber size and/or dilated left atrium. Results At baseline, hypertension was present in 63%, and 36% used biologic DMARDs (bDMARDs). Preclinical cardiac organ damage was not influenced by rosuvastatin treatment (44% at baseline vs 50% at follow-up, P = 0.42). In uni- and multivariable logistic regression analyses, risk of preclinical cardiac organ damage at follow-up was increased by higher baseline body mass index [odds ratio (OR) 1.3, 95% CI: 1.1, 1.5, P = 0.01] and presence of preclinical cardiac organ damage at baseline (OR 6.4, 95% CI: 2.2, 18.5, P = 0.001) and reduced by use of bDMARDs at follow-up (OR 0.3, 95% CI: 0.1, 0.9, P = 0.03). Conclusion Rosuvastatin treatment was not associated with a reduction in preclinical cardiac organ damage in IJD patients after 18 months of treatment. However, use of bDMARDS at follow-up was associated with lower risk of preclinical cardiac organ damage at study end, pointing to a possible protective cardiac effect of bDMARDs in IJD patients. ClinicalTrials.gov https://clinicaltrials.gov/NCT01389388

Objective The European guidelines on cardiovascular disease (CVD) prevention advise use of relative risk and risk age algorithms for estimating CVD risk in patients with low estimated absolute risk. Patients with inflammatory joint diseases (IJD) are associated with increased risk of CVD. We aimed to estimate relative risk and risk age across IJD entities and evaluate the agreement between ‘cardiovascular risk age' and ‘vascular age models'. Methods Using cross-sectional data from a nationwide project on CVD risk assessment in IJD, risk age estimations were performed in patients with low/moderate absolute risk of fatal CVD. Risk age was calculated according to the cardiovascular risk age and vascular age model, and risk age estimations were compared using regression analysis and calculating percentage of risk age estimations differing ≥5years. Results Relative risk was increased in 53% and 20% had three times or higher risk compared to individuals with optimal CVD risk factor levels. Furthermore, 20–42% had a risk age ≥5years higher than their actual age, according to the specific risk age model. There were only minor differences between IJD entities regarding relative risk and risk age. Discrepancies ≥5years in estimated risk age were observed in 14–43% of patients. The largest observed difference in calculated risk age was 24years. Conclusion In patients with low estimated absolute risk, estimation of relative CVD risk and risk age may identify additional patients at need of intensive CVD preventive efforts. However, there is a substantial discrepancy between the risk age models.

Cardiovascular disease (CVD) risk calculators developed for the general population have been shown to inaccurately predict CVD events in patients with inflammatory joint disease (IJD). European guidelines for CVD prevention recognize the presence of carotid plaques (CP) as a very high CVD risk factor, equivalent of coronary artery disease. Patients with IJD have a high prevalence of CP. We evaluated if CP resulted in reclassification of patients with IJD into a more appropriate CVD risk class and recommended lipid lowering treatment.CVD risk evaluation was performed in patients with IJD using SCORE and ACC/AHA risk calculators to predict CVD events.Of the 335 IJD patients evaluated (including rheumatoid arthritis n=201, ankylosing spondylitis n=85 and psoriatic arthritis n=49), 183 and 159 IJD patients had a calculated CVD risk by SCORE and ACC/AHA5%, indicating no need of lipid lowering treatment (LLT). However, of patients with low to moderate risk calculated by SCORE and ACC/AHA, 67 (36.6%) and 48 (30.2%) had CP and should according to guidelines receive intensive LLT. For patients with high risk, in the LLT considered group, 54.9% and 58.1% were reclassified to correct treatment when adding information on the presence of CP. Our results reveal a considerable reclassification into correct CVD risk category when adding CP in female patients.The high frequency of asymptomatic atherosclerosis in patients with IJD has a notable impact on CVD risk stratification. Identification of CP will reclassify patients into recommended CVD preventive treatment group, which may be clinically important.

Smoking cessation in patients with RA is associated with reduced CVD event rates and improved lipid profiles and predicts lower RA disease activity

Background The objective of this study was to explore the associations between ultrasonographic and radiographic joint scores and levels of arterial CVD risk markers in patients with osteoarthritis (OA). Secondly, to compare the levels of arterial CVD risk markers between OA phenotypes and controls. Method The “Musculoskeletal pain in Ullensaker” Study (MUST) invited residents of Ullensaker municipality with self-reported OA to a medical examination. OA was defined according to the American College of Rheumatology (ACR) criteria and phenotyped based on joint distribution. Joints of the hands, hips and knees were examined by ultrasonography and conventional radiography, and scored for osteosteophytes. Hands were also scored for inflammation by grey scale (GS) synovitis and power Doppler (PD) signal. Control populations were a cohort of inhabitants of Oslo (OCP), and for external validation, a UK community-based register (UKPC). Pulse pressure augmentation index (AIx) and pulse wave velocity (PWV) were measured using the Sphygmocor apparatus (Atcor®). Ankel-brachial index (ABI) was estimated in a subset of patients. In separate adjusted regression models we explored the associations between ultrasonography and radiograph joint scores and AIx, PWV and ABI. CVD risk markers were also compared between phenotypes of OA and controls in adjusted analyses. Results Three hundred and sixty six persons with OA were included (mean age (range); 63.0 (42.0–75.0)), (females (%); 264 (72)). Of these, 155 (42.3%) had isolated hand OA, 111 (30.3%) had isolated lower limb OA and 100 (27.3%) had generalized OA. 108 persons were included in the OCP and 963 persons in the UKPC; (mean age (range); OCP: 57.2 (40.4–70.4), UKPC: 63.9 (40.0–75.0), females (%); OCP: 47 (43.5), UKPC: 543 (56.4%). Hand osteophytes were associated with AIx while GS and PD scores were not related to CVD risk markers. All OA phenotypes had higher levels of AIx compared to OCP in adjusted analyses. External validation against UKPC confirmed these findings. Conclusions Hand osteophytes might be related to higher risk of CVD. People with OA had higher augmented central pressure compared to controls. Words 330. Electronic supplementary material The online version of this article (10.1186/s41927-019-0081-8) contains supplementary material, which is available to authorized users.

Background The effect of statins over time on coronary atherosclerosis in patients with inflammatory joint diseases (IJD) is unknown. Our aim was to evaluate the change in coronary plaque morphology and volume in long-term statin-treated patients with IJD. Methods Sixty-eight patients with IJD and carotid artery plaque(s) underwent coronary computed tomography angiography before and after a mean of 4.7 (range 4.0–6.0) years of statin treatment. The treatment target for low density lipoprotein cholesterol (LDL-c) was ≤1.8 mmol/L. Changes in plaque volume (calcified, mixed/soft and total) and coronary artery calcification (CAC) from baseline to follow-up were assessed using the 17-segment American Heart Association-model. Results Median (IQR) increase in CAC after statin treatment was 38 (5–236) Agatston units (p1.8mmol/L (21 [2–143] vs. 69 [16–423], p = 0.006 and 0.65 [-1.0–13.9] vs. 13.0 [0.0–60.8] mm3, p = 0.019, respectively). Conclusions A progression of total atherosclerotic plaque volume in statin-treated patients with IJD was observed. However, soft/mixed plaque volume was reduced, suggesting an alteration in plaque composition. Patients with recommended LDL-c levels at follow-up had reduced atherosclerotic progression compared to patients with LDL-c levels above the treatment target, suggesting a beneficial effect of treatment to guideline-recommended lipid targets in IJD patients.

The long-term pulmonary outcomes of coronavirus disease 2019 (COVID-19) are unknown. We aimed to describe self-reported dyspnoea, quality of life, pulmonary function, and chest CT findings three months following hospital admission for COVID-19. We hypothesised outcomes to be inferior for patients admitted to intensive care units (ICU), compared with non-ICU patients. Discharged COVID-19-patients from six Norwegian hospitals were consecutively enrolled in a prospective cohort study. The current report describes the first 103 participants, including 15 ICU patients. Modified Medical Research Council dyspnoea scale (mMRC), EuroQol Group's Questionnaire, spirometry, diffusion capacity (DLCO), six-minute walk test, pulse oximetry, and low-dose CT scan were performed three months after discharge. mMRC was >0 in 54% and >1 in 19% of the participants. The median (25th–75th percentile) forced vital capacity and forced expiratory volume in one second were 94% (76, 121) and 92% (84, 106) of predicted, respectively. DLCO was below the lower limit of normal in 24%. Ground-glass opacities (GGO) with >10% distribution in ≥1 of 4 pulmonary zones were present in 25%, while 19% had parenchymal bands on chest CT. ICU survivors had similar dyspnoea scores and pulmonary function as non-ICU patients, but higher prevalence of GGO (adjusted odds ratio [95% confidence interval] 4.2 [1.1, 15.6]) and performance in lower usual activities. Three months after admission for COVID-19, one fourth of the participants had chest CT opacities and reduced diffusion capacity. Admission to ICU was associated with pathological CT findings. This was not reflected in increased dyspnoea or impaired lung function., Three months after discharge, one-fourth of COVID-19 survivors have reduced gas diffusion capacity and persistent parenchymal opacities. ICU treatment is associated with persistent parenchymal opacities, but not with dyspnoea or reduced diffusion capacity.

Background:The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. In subjects with coronary heart disease (CHD), audits of CVD risk factor control are regularly performed, which makes it possible to evaluate guideline implementation over time.1Updated surveys on CVD risk management in patients with RA are needed.Objectives:To describe differences in lipid and blood pressure (BP) levels among patients with RA from five world regions. Furthermore, to evaluate attainment of guideline recommended targets for lipid lowering and antihypertensive treatment.Methods:The SUrvey of CVD Risk Factors in patients with RA (SURF-RA) was conducted at 53 centres in 19 countries from 2014 to 2019. Data including demographics, RA disease characteristics, CVD comorbidity, risk factors and use of preventive treatment was collected. HT was defined as self-reported HT, and/or measured BP ≥140/90 mmHg, and/or use of anti HT medication (a-HT). The treatment goal of a-HT was BP 2Results:In total, 14503 RA patients were included. The mean age was 59.8±13.6 years, and it was a strong female preponderance (74%). Nearly 2/3 of the patients were hypertensive. Use of a-HT in the total population differed substantially between the cohorts with limited use in West Europe and Latin America (17.4% and 24.8%), in contrast to North America and East Europe (46.8% and 57.0%). On average, half of those with HT were at the recommended BP goal. The lowest BP goal attainment was seen in Asia, West and East Europe (40.8-43.1%), and the highest in North America (63.5%). Overall 51.5% had an indication for lipid lowering therapy (LLT), and of these 43.5% were taking LLT. Only 34.0% of patients with an indication for LLT were at recommended LDL-c goals. The proportion of RA patients on target for LDL-c varied greatly between regions, from 23.1% in East Europe to 51.0% in North America. The LDL-c goal attainment was higher in RA patients at high risk (45.1%) compared to those at very high risk of CVD (18.0%).Conclusion:This large international survey on RA patients revealed considerable geographical differences in CVD preventive treatment. Lower goal attainment for LLT than reported for subjects with CHD was observed. We conclude that there is a substantial need for improvement in CVD preventive measures in RA patients.References:[1]De Backer G, Jankowski P, Kotseva K,et al.Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries.Atherosclerosis. 2019;285:135-146.[2]Perk J, De Backer G, Gohlke H,et al.European Guide-lines on cardiovascular disease prevention in clinical practice.Eur Heart J.2012:1635-701.Disclosure of Interests:Silvia Rollefstad: None declared, Eirik Ikdahl: None declared, Joe Sexton: None declared, Georeg Kitas: None declared, Piet van Riel: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Ian Graham: None declared, Anne Grete Semb: None declared

Background:The cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is comparable to that of patients with diabetes mellitus (DM). Although several studies have indicated high prevalences of glucose intolerance and DM in RA patients, little is known about how this affects their CVD risk.Objectives:To examine indications for, and use of antihypertensive treatment (AntiHT) and lipid-lowering therapy (LLT) in RA patients with DM (RA-DM) and RA patients without DM (RAwoDM). Further, to compare the prevalence of various types of CVD across RA-DM and RAwoDM.Methods:The cohort was derived from theSUrvey of cardiovascular diseaseRiskFactor in patients withRheumatoidArthritis (SURF-RA), which was performed in 53 centres across 17 countries in 5 world regions (West and East Europe; North and Latin America; and Asia) from January 2014 to August 2019. Indication for AntiHT was defined as: 1) systolic/diastolic blood pressure (BP) ≥ 140/90 mm Hg, 2) self-reported hypertension, and/or 3) current use of AntiHT. Indication for LLT was defined according to European Society of Cardiology (ESC) guidelines (1), in which the Systematic Coronary Risk Evaluation (SCORE) is applied. SCORE risk estimates were multiplied by 1.5 according to EULAR recommendations. Target treatment targets for blood pressure and lipids were defined according to ESC guidelines applicable at the time when data were recorded.Results:Presence of comorbid DM was available in 10 602 (73.1 %) of the 14 503 RA patients included in SURF-RA, of whom 75 and 1262 patients reported DM type 1 and type 2, respectively (total 1337 patients, 12.6 %). Although less often current smokers, RA-DM patients were more often previous smokers, male sex and had higher body mass index compared to RAwoDM (pConclusion:The effect of RA and comorbid DM on CVD risk appears to be additive. While CVD preventive medications are more often indicated in RA-DM than in RAwoDM patients, they are also more likely to receive such therapy and to reach CVD preventive treatment goals. The latter finding may be due to more developed CVD preventive care in DM compared to RA patients. Improved CVD preventive systems for patients with RA are warranted.References:[1]Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C,et al. European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2012:1635-701.Disclosure of Interests:Eirik Ikdahl: None declared, Silvia Rollefstad: None declared, Joe Sexton: None declared, Birgitte Nellemann: None declared, Georeg Kitas: None declared, Piet Van Riel: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Ian Graham: None declared, Anne Grete Semb: None declared

Background:Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD).Observational data suggest a need for improved risk factor recording and management in such subjects.Objectives:The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA and CVD preventive medication in patient with RA.Methods:The audit is termedSUrvey of cardiovascular diseaseRiskFactors in patients withRheumatoidArthritis (SURF-RA) and was performed in 53 centres in 19 countries across 5 world regions during 2014 and 2019. SURF-RA is part of the SURF family of audits which have been performed in patients with CHD, in primary care2, and now in patients with stroke and SLE. Data including demographics, RA disease characteristics, CVD, risk factors and medications was collected. The survey was approved by the Data Protection Officer (2017/7243) and a General Data Protection evaluation has been performed (10/10-2018).Results:Among 14 503 patients with RA in West (n= 8 493) and East (n=923) Europe, Latin (n=407) and North (n=4030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The average disease activity was low [disease activity score including 28 joints and C-reactive protein; DAS28CRP: mean (SD): 2.6 (1.2)]. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol > 2.5 mmol/L: 63.3%. Overall, 29% used anti-hypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index > 30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2 %, lowest in Asia (7.8%) and highest in East Europe (28.5%).Conclusion:The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population.References:[1] Cooney MTet al. SURF-Survey of Risk Factor management: First report of an international audit. Eur J Prev cardiol 2014[2] Zao M, Cooney MT, Klipstein-Grobush K, et al. Simplifying the audit of risk factor recording and control: A report from an international study in 11 countries. Eur J Prev Cardiol 2016AllWest EuropeEastEuropeLatinAmericaNorth AmericaAsiap-valueNumber of patients1450384939234074030650Age mean(SD)59.8 (13.6)60.7 (13.2)58.8 (11.8)52.8 (11.6)59.4 (14.8)55.7 (13.1)Sex female (%)74.574.178.592.472.277.3Disease duration (yrs) mean(SD)10.8 (9.5)10.5 (9.5)12.1 (9.3)9.9 (7.5)12.6 (9.8)10.5 (9.8)DAS28-CRP mean(SD)2.6 (1.2)2.5 (1.1)2.9 (1.2)2.8 (1.3)2.8 (1.2)2.8 (1.4)Atherosclerotic CVD (%)13.311.421.42.516.210.3Lipid lowering medication (%)26.425.128.522.431.17.2Any anti-hypertensive (%)29.017.457.024.846.831.8Disclosure of Interests:Anne Grete Semb: None declared, Eirik Ikdahl: None declared, Joe Sexton: None declared, Georeg Kitas: None declared, Piet van Riel: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Ian Graham: None declared, Silvia Rollefstad: None declared

Cardiovascular risk age and vascular age estimations in predicting cardiovascular events in rheumatoid arthritis patients

Background Statins have an established preventive effect on coronary artery disease in the general population. The effect of statins on coronary plaque progression and characteristics in patients with inflammatory joint diseases (IJD) is unknown. Objectives Our aim was to evaluate the change in coronary atherosclerosis in long-term statin-treated patients with IJD. Methods Sixty-eight patients with IJD and carotid artery plaque, underwent coronary computed tomography angiography before and after 4.7 (range 4.0–6.0) years of statin treatment. The treatment target for low density lipoprotein cholesterol (LDL-c) was ≤1.8 mmol/L. Changes in coronary artery calcification (CAC) and coronary artery plaque volume (calcified, mixed/soft and total) from baseline to follow-up were assessed using the 17-segment model of the American Heart Association. Linear regression analysis was used to identify predictors of atherosclerotic progression. Results Coronary plaques were present in 42% of the patients at baseline and in 51% at follow up. Mean CAC score increased with 173±284, calcified plaque volume with 39.4±78.3 mm3 and total plaque volume with 22.8±54.6 mm3 (p≤0.01, for all) (figure 1). Mean mixed/soft plaque volume decreased with −10.4±27.5 mm3 (p≤0.01). At follow-up, 51% of the patients had obtained LDL-c treatment target. Compared to patients above LDL-c target, patients with an LDL-c ≤1.8 mmol/L experienced reduced median progression of both CAC (212–143 vs. 69 [16–423], p Conclusions We revealed a progression of atherosclerotic plaque volume in statin-treated patients with IJD, mainly due to calcifications. However, soft, unstable plaques were reduced, probably as a result of an alteration in plaque composition from mixed/soft plaques into calcified plaques. Patients with recommended LDL-c levels at follow-up experienced a reduced atherosclerotic progression compared to patients with LDL-c levels above the treatment target. Our results support the importance of treatment to guideline recommended lipid targets in IJD patients. Disclosure of Interest None declared

Patients with inflammatory joint diseases (IJD) have an increased risk of cardiovascular disease (CVD). Our goal was to examine indications for, and use of, lipid-lowering therapy (LLT) and antihypertensive treatment (AntiHT) in patients with IJD. Furthermore, to investigate the frequency of low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) goal attainment among IJD patients.The cohort was derived from the NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR). Indications for AntiHT were: systolic/diastolic BP ≥ 140/90 mm Hg, self-reported hypertension or AntiHT. CVD risk was estimated by the systematic coronary risk evaluation (SCORE) algorithm. LDL-c goals were2.6 mmol/L in case of diabetes, total cholesterol 8 mmol/L or a SCORE estimate ≥ 5%, and1.8 mmol/L for those with established CVD or SCORE ≥ 10%. Comparisons across IJD entities were performed using age and sex adjusted logistic regression.In total, 2277 patients (rheumatoid arthritis: 1376, axial spondyloarthritis: 474, psoriatic arthritis: 427) were included. LLT and AntiHT were indicated in 36.1% and 52.6% of the patients, of whom 37.6% and 47.0% were untreated, respectively. LDL-c and BP targets were obtained in 26.2% and 26.3%, respectively. Guideline recommended treatment and/or corresponding treatment targets were not initiated or obtained in approximately 50%. Rheumatoid arthritis patients were particularly likely to be undertreated with LLT, whereas hypertension undertreatment was most common in psoriatic arthritis.Inadequate CVD prevention encompasses all the three major IJD entities. The unmet need for CVD preventive measures is not only prevalent in RA, but exists across all the major IJD entities.

ObjectivesPatients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA.MethodsIn 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.Results5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all pConclusionsIn a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

Objective Patients with rheumatoid arthritis (RA) and carotid artery plaques have an increased risk of acute coronary syndromes. Statin treatment with the goal of achieving a low-density lipoprotein (LDL) cholesterol level of ≤1.8 mmoles/liter (≤70 mg/dl) is recommended for individuals in the general population who have carotid plaques. The aim of the ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases (RORA-AS) study was to evaluate the effect of 18 months of intensive lipid-lowering treatment with rosuvastatin with regard to change in carotid plaque height. Methods Eighty-six patients (60.5% of whom were female) with carotid plaques and inflammatory joint disease (55 with RA, 21 with AS, and 10 with psoriatic arthritis) were treated with rosuvastatin to obtain the LDL cholesterol goal. Carotid plaque height was evaluated by B-mode ultrasonography. Results The mean ± SD age of the patients was 60.8 ± 8.5 years, and the median compliance with rosuvastatin treatment was 97.9% (interquartile range [IQR] 96.0–99.4). At baseline, the median number and height of the carotid plaques were 1.0 (range 1–8) and 1.80 mm (IQR 1.60–2.10), respectively. The mean ± SD change in carotid plaque height after 18 months of treatment with rosuvastatin was −0.19 ± 0.35 mm (P < 0.0001). The mean ± SD baseline LDL cholesterol level was 4.0 ± 0.9 mmoles/liter (154.7 ± 34.8 mg/dl), and the mean reduction in the LDL cholesterol level was −2.3 mmoles/liter (95% confidence interval [95% CI] −2.48, −2.15) (−88.9 mg/dl [95% CI −95.9, −83.1]). The mean ± SD LDL cholesterol level during the 18 months of rosuvastatin treatment was 1.7 ± 0.4 mmoles/liter (area under the curve). After adjustment for age/sex/blood pressure, no linear relationship between a reduction in carotid plaque height and the level of LDL cholesterol exposure during the study period was observed. Attainment of the LDL cholesterol goal of ≤1.8 mmoles/liter (≤70 mg/dl) or the amount of change in the LDL cholesterol level during the study period did not influence the degree of carotid plaque height reduction. Conclusion Intensive lipid-lowering treatment with rosuvastatin induced atherosclerotic regression and reduced the LDL cholesterol level significantly in patients with inflammatory joint disease.

Objective Low association between cardiac symptoms and coronary artery disease (CAD) in patients with inflammatory joint diseases (IJD) demands for objective markers to improve cardiovascular risk stratification. Our main aim was to evaluate the prevalence and characteristics of CAD in patients with IJD with carotid artery plaques. Furthermore, we aimed to assess associations of carotid ultrasonographic findings and coronary plaques. Methods Eighty-six patients (61% female) with IJD (55 with rheumatoid arthritis, 21 with ankylosing spondylitis and 10 with psoriatic arthritis) and carotid artery plaque were referred to coronary CT angiography (CCTA). CAD was evaluated using the modified 17-segment American Heart Association model. Calcium score, plaque composition, segment involvement score and segment stenosis score were assessed and correlated to the carotid artery plaques and cardiovascular disease risk factors in logistic and linear regression analyses. Risk prediction models were tested with various cut-off values for associating variables. Results Fifty-five patients (66%) had CAD assessed by CCTA and 36 (43%) of these had coronary plaques defined as either mixed or soft. Eleven patients (13%) had obstructive CAD. The best risk prediction model (area under the curve: 0.832, 95% CI 0.730 to 0.935) included the combination of variables with cut-off values: age ≥55 years (OR: 12.18, 95% CI 2.80 to 53.05), the carotid-intima media thickness ≥0.7 mm (OR: 4.08, 95% CI 1.20 to 13.89) and carotid plaque height ≥1.5 mm (OR: 8.96, 95% CI 1.68 to 47.91), p Conclusion Presence of carotid plaque is alone not sufficient to identify patients at risk for CAD, and a combination of ultrasonographic measurements may be useful in risk stratification of patients with IJD. Trial registration number NCT01389388, Results.

Background The excess risk of cardiovascular disease (CVD) in patients with inflammatory joint diseases (IJD) is attributable to several risk factors, including a high prevalence of hypertension. However, there is limited knowledge on the effect of antihypertensive treatment (a-HTT) in these patients. Objectives Our objective was to initiate a-HTT when indicated and treat to guideline recommended blood pressure (BP) goal in IJD patients. We also aimed to evaluate the effect of a-HTT in this patient population, and which factors were associated with BP goal attainment. Methods Patients with IJD (n=765) were referred from a rheumatology outpatient clinic or general practitioners to a preventive cardio-rheuma clinic. All patients underwent a CVD risk evaluation, including BP measurements (performed using and Omron M7 apparatus). Antihypertensive treatment was initiated in accordance with guidelines, and the BP treatment goal was Results Of the 765 IJD patients referred (rheumatoid arthritis n=450, ankylosing spondylitis n=210 and psoriatic arthritis n=105), 104 (13.6%) had an indication for BP lowering, while 224 (29.3%) were already using a-HTT at the first consultation. For those where a-HTT was initiated at baseline (n=104), there was a highly significant change in BP from first to final consultation (Fig 1a). BP goal was achieved in 84 (80.8%) patients (Fig 1b), using mean±SD 3.1±1.7 consultations. Dose adjustments was done in 38 (36.5%) of the patients with median (IQR) a-HTT dose adjustments of 1 (1, 1.25). In 9 (8.7%) patients the a-HTT was changed. Systolic BP (p Conclusions This is to our knowledge the first prospective report on success rate of BP goal achievement in patients with IJD. Approximately 80% reached BP target, which is even a higher proportion than what is shown in the general population. Treatment to BP goal is feasible in patients with IJD, and is not complicated by inflammation or use of anti-rheumatic medication. Disclosure of Interest None declared

Background Individuals with inflammatory joint diseases (IJD) [rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA)] have increased risk of cardiovascular disease (CVD). In the European guidelines for CVD prevention, calculation of relative risk and risk age is advised in patients with low absolute risk of fatal CVD events the next 10 years estimated by the systematic coronary risk evaluation [SCORE] algorithm; the rational being that low absolute risk may conceal high relative risk and risk ages far beyond chronological age. Thus, more patients needing intensive CVD prevention may be identified. Relative risk is a ratio comparing absolute CVD risk in a specific patient to the risk given optimal CVD risk factor levels (CVDRFs). Risk age denotes the age with similar CVD risk and optimal CVDRFs. To this date, no studies have evaluated relative risk and risk age across IJD entities, neither has the agreement between different risk age models been investigated. Objectives 1) Estimate relative risk and risk age across IJD entities. 2) Investigate agreement between different risk age models. Methods RA/axSpA/PsA patients aged 40≤65 years with low/moderate 10-year risk of fatal CVD were included from a nationwide quality assurance project implementing CVD risk assessment. Relative risk and cardiovascular risk age was calculated in accordance with risk charts published by the European Society of Cardiology (2016) and Cooney et al (2012), respectively. Vascular age was calculated by matching SCORE to estimated risk ages in accordance with Cuende et al (2010). Four different vascular age estimations were calculated, depending on whether the EULAR 1.5 multiplication factor in RA was applied (mSCORE) and if SCORE version with HDL-c (SCORE-HDL-c) was used: SCORE, SCORE-HDL-c, mSCORE and mSCORE-HDL-c. Risk years beyond chronologic age, were calculated. Linear regression models were used to investigate agreement between risk age estimations. Results Relative risk was increased in 53% of all patients and 20% had three times the risk or higher compared to individuals with optimal CVDRF levels. In total, 42% and 20% had a risk age ≥5 years higher than their chronologic age, according to the cardiovascular risk age model and the vascular age model derived from SCORE, respectively. There were minor differences between RA, axSpA and PsA patients in terms of relative risk and risk age. Agreement between cardiovascular risk age and various vascular age models varied (Figure). Discrepancies ≥5 years in estimated risk age were observed in 14–43% of estimations. The largest observed difference in calculated risk age was 24 years. Similarly, linear regression models yielded a R2 of 0.81–0.96. Across all models, median difference between risk age and age increased with advancing relative risk. Moreover, several patients had high relative risk despite a risk age close to their chronologic age. Conclusions Relative risk and risk age may identify several patients at high need of intensive CVD preventive efforts despite low estimated absolute risk. However, there are considerable discrepancies between risk age models. Disclosure of Interest None declared

Background Patients with inflammatory joint diseases (IJD) have increased risk of cardiovascular disease (CVD). Our aim was to compare CVD risk profiles in patients with IJD, including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) and evaluate the future risk of CVD. Methods The prevalence and numbers of major CVD risk factors (CVD-RFs) (hypertension, elevated cholesterol, obesity, smoking, and diabetes mellitus) were estimated in patients with RA, axSpA and PsA. Relative and absolute risk of CVD according to Systematic Coronary Risk Evaluation (SCORE) was calculated. Results In total, 3791 patients were included. CVD was present in 274 patients (7.2%). Of those without established CVD; hypertension and elevated cholesterol were the most frequent CVD-RFs, occurring in 49.8% and 32.8% of patients. Patients with PsA were more often hypertensive and obese. Overall, 73.6% of patients had a minimum of one CVD-RF, which increased from 53.2% among patients aged 30 to

Although there is a large body of knowledge on the increased cardiovascular disease (CVD) risk in rheumatoid arthritis (RA), there is a lack of clinical evidence on management of the increased risk.

According to the World Health Organization (WHO), around three quarters of all cardiovascular disease (CVD) events can be prevented by improving lifestyle-related CVD risk factors. In patients with rheumatoid arthritis (RA), the relative impact of lifestyle-related risk factors on CVD outcome, including smoking, unfavorable body compositions, unhealthy diets, and physical inactivity, remain undetermined.

Objective.We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD.Methods.In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses.Results.Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline.Conclusion.CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.

Objective Patients with inflammatory joint diseases (IJD) have a high prevalence of hypertension and increased arterial stiffness. The aim of the present study was to evaluate the effect of long-term rosuvastatin treatment on arterial stiffness, measured by augmentation index (AIx) and aortic pulse wave velocity (aPWV), and blood pressure (BP) in IJD patients with established atherosclerosis. Methods Eighty-nine statin naive IJD patients with carotid atherosclerotic plaque(s) (rheumatoid arthritis n = 55, ankylosing spondylitis n = 23, psoriatic arthritis n = 11) received rosuvastatin for 18 months to achieve low-density lipoprotein cholesterol goal ≤1.8 mmol/L. Change in AIx (ΔAIx), aPWV (ΔaPWV), systolic BP (ΔsBP) and diastolic BP (ΔdBP) from baseline to study end was assessed by paired samples t-tests. Linear regression was applied to evaluate associations between cardiovascular disease (CVD) risk factors, rheumatic disease specific variables and medication, and ΔAIx, ΔaPWV, ΔsBP and ΔdBP. Results AIx, aPWV, sBP and dBP were significantly reduced from baseline to study end. The mean (95%CI) changes were: ΔAIx: -0.34 (-0.03, -0.65)% (p = 0.03), ΔaPWV: -1.69 (-0.21, -3.17)m/s2 (p = 0.03), ΔsBP: -5.27 (-1.61, -8.93)mmHg (p = 0.004) and ΔdBP -2.93 (-0.86, -5.00)mmHg (p = 0.01). In linear regression models, ∆aPWV was significantly correlated with ΔsBP and ΔdBP (for all: p

Objectives The relation between chest pain and coronary atherosclerosis (CA) in patients with inflammatory joint diseases (IJD) has not been explored previously. Our aim was to evaluate the associations of the presence of chest pain and the predicted 10-year risk of cardiovascular disease (CVD) by use of several CVD risk algorithms, with CA verified by multidetector computed tomography (MDCT) coronary angiography. Methods Detailed information concerning chest pain and CVD risk factors was obtained in 335 patients with rheumatoid arthritis and ankylosing spondylitis. In addition, 119 of these patients underwent MDCT coronary angiography. Results Thirty-one percent of the patients (104/335) reported chest pain. Only six patients (1.8%) had atypical angina pectoris (pricking pain at rest). In 69 patients without chest pain, two thirds had CA, while in those who reported chest pain (n = 50), CA was present in 48.0%. In a logistic regression analysis, chest pain was not associated with CA (dependent variable) (p = 0.43). About 30% (Nagelkerke R2) of CA was explained by any of the CVD risk calculators: Systematic Coronary Risk Evaluation, Framingham Risk Score, or Reynolds Risk Score. Conclusion The presence of chest pain was surprisingly infrequently reported in patients with IJD who were referred for a CVD risk evaluation. However, when present, chest pain was weakly associated with CA, in contrast to the predicted CVD risk by several risk calculators which was highly associated with the presence of CA. These findings suggest that clinicians treating patients with IJD should be alert of coronary atherosclerotic disease also in the absence of chest pain symptoms.

ObjectiveThe European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits.MethodsThe NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients’ CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures.ResultsData collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres.ConclusionPatients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.

Introduction Endothelial dysfunction is an early step in the atherosclerotic process and can be quantified by flow-mediated vasodilation (FMD). Our aim was to investigate the effect of long-term rosuvastatin therapy on endothelial function in patients with inflammatory joint diseases (IJD) with established atherosclerosis. Furthermore, to evaluate correlations between change in FMD (ΔFMD) and change in carotid plaque (CP) height, arterial stiffness [aortic pulse wave velocity (aPWV) and augmentation index (AIx)], lipids, disease activity and inflammation. Methods Eighty-five statin-naïve patients with IJD and ultrasound-verified CP (rheumatoid arthritis: n = 53, ankylosing spondylitis: n = 24, psoriatic arthritis: n = 8) received rosuvastatin treatment for 18 months. Paired-samples t tests were used to assess ΔFMD from baseline to study end. Linear regression models were applied to evaluate correlations between ∆FMD and cardiovascular risk factors, rheumatic disease variables and medication. Results The mean ± SD FMD was significantly improved from 7.10 ± 3.14 % at baseline to 8.70 ± 2.98 % at study end (p

Objectives There is a lipid paradox in rheumatoid arthritis describing that despite low lipids related to systemic inflammation, there is an increased cardiovascular (CV) risk. Our aim was to evaluate if baseline lipid levels or baseline systemic inflammation were associated with the statin dose sufficient to achieve lipid targets in patients with inflammatory joint diseases. Methods In this longitudinal, short-term follow-up observational report, we evaluated 197 patients who did and 36 patients who did not reach the recommended low density lipoprotein cholesterol (LDL-c) target. The patients were, after CV risk evaluation, classified to either primary or secondary CV prevention with lipid lowering treatment (LLT). LLT was initiated with statins and adjusted until at least two lipid targets were achieved. Intensive LLT was defined as rosuvastatin ≥20 mg, atorvastatin and simvastatin at the highest dose (80 mg), and conventional LLT were defined as all lower doses. Results In an independent sample t test, systemic inflammation or lipid levels at baseline were not associated with the statin dose (intensive or conventional) needed to achieve recommended LDL-c target (C reactive protein/erythrocyte sedimentation rate: p=0.10 and p=0.11, and LDL-c/total cholesterol: p=0.17 and p=0.34, respectively). The baseline inflammatory status and lipid levels in patients who did and did not obtain LDL-c goal were comparable (C reactive protein/erythrocyte sedimentation rate: p=0.32 and p=0.64, and LDL-c/total cholesterol: p=0.20 and p=0.83, respectively). Conclusions Systemic inflammation or lipid levels did not influence the intensity of statin treatment needed to obtain guideline recommended lipid targets in CV prevention. Whether the background inflammation in patients with inflammatory joint diseases over time influences the CV risk reduction related to statins is yet unknown.

Background In the general population it is well documented that females have their CVD diagnosed at a later stage compared to males. Wether this is true also for rheumatoid arthritis (RA) patients is not known. Objectives To evaluate if cardiovascular disease (CVD) risk prediction and event rates differed between the sexes, and if adjustments for traditional and RA specific risk factors were of importance. Methods RA cohorts from 13 rheumatology centers were compared. Data on CVD risk factors and RA characteristics were collected at baseline; CVD outcomes were collected using standardized definitions. Standardized incidence ratios (SIR) were calculated with respect to sex using the following risk calculators FRS, SCORE, ACC/AHA and QRISK II. Results 5638 patients with RA and no prior CVD were included (mean age: 55.3 [SD: 14.0] years, 76% female). During a mean follow-up of 5.8 (SD: 4.4) years, 437 patients developed CVD events. SIRs (95% CI) using the various CVD risk calculators were for females and males: FRS: 1.02 (0.80, 1.31) and 0.86 (0.67, 1.12) (p=0.19), SCORE: 0.34 (0.17, 0.67) and 0.25 (0.11, 0.58) (p=0.98), ACC/AHA: 0.72 (0.50, 1.04) and 0.56 (0.36, 0.88) (p=0.74) and QRISKII 0.61 (0.47, 0.79) and 0.52 (0.35, 0.79) (p=0.42). The 10 year CVD-free survival differed significantly between the sexes, when adjusting for a) age, b) age and CVD risk factors and c) age, CVD risk factors and RA disease characteristics (Females [mean %±SD] 88.3±0.3, males 79.4±0.4), p Conclusions In a large international cohort of patients with RA, there was no sex difference in the ability of the various risk calculators to predict CVD. CVD-free survival was significantly higher in females, even after adjustments for both traditional and RA specific risk factors. Acknowledgement ATACC-RA collaborators: T.K. Kvien (Diakonhjemmet hospital, Oslo, Norway), E.L. Matteson (Mayo Clinic, Rochester, United States), K. Douglas and A. Sandoo (Dudley Group NHS Foundation Trust, West Midlands, United Kingdom), E. Arts and J. Fransen (Radboud University Medical Centre, Nijmegen, Netherlands), P.P. Sfikakis and E. Zampeli (University of Athens, Athens, Greece), S. Rantapaa-Dahlqvist and S. Wallberg-Jonsson and L. Innala (University of Umea, Umea, Sweden), G. Karpouzas (Harbor UCLA Medical Center RHU, Torrance, United States), D. Solomon and K. Liao (Harvard Medical School Brigham and Women9s Hospital, Boston, United States), M.A. Gonzalez-Gay and A. Corrales (Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain), P.H. Dessein and L. Tsang (University of Witwatersrand, Johannesburg, South Africa), H. El-Gabalawy and C. Hitchon (University of Manitoba, Winnipeg, Manitoba, Canada), V.P. Ramos and I.C. Yanez (Instituto Nacional de Ciencias Medicas y Nutriciόn Salvador Zubiran, Mexico City, Mexico), M. van de Laar and H. Vonkeman and I. Meek (Hospital Medisch Spectrum Twente, Enschede, Netherlands), E. Husni and R. Overman (Cleveland Clinic, Cleveland, United States), I. Colunga and D. Galarza (Hospital Universitario “Dr. Jose E. Gonzalez”, Monterrey, Mexico) Disclosure of Interest None declared

Background Antihypertensives (antiHT) and lipid lowering therapies (LLT) prevent cardiovascular disease (CVD) effectively. It has been reported that patients with rheumatoid arthritis (RA) receive suboptimal CVD-prevention, possibly contributing to their increased CVD risk. Whether other inflammatory joint diseases (IJD), such as ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other spondyloarthropathies (SpA), also receive inadequate CVD management remains unknown. Objectives In a large IJD cohort we aimed to evaluate 1) Rate of indications for antiHT and/or LLT, 2) rate of antiHT and/or LLT initiation, and 3) blood pressure (BP) and low-density lipoprotein cholesterol (LDL) goal attainment in patients treated with antiHT or LLT, respectively. Methods The present IJD cohort is derived from the Norwegian COllaboration on Cardiovascular disease in patients with Rheumatic joint diseases (NOCAR). In NOCAR, CVD risk factors are collected in daily rheumatology practice. Need for antiHT was defined as systolic BP (sBP) ≥140mmHg, diastolic BP (dBP) ≥90 mmHg or self-reported hypertension (HT). sBP/dBP levels 8 mmol/L, LDL >6 mmol/L) or SCORE ≥5% are at high CVD risk and should receive LLT (LDL target Results Fifty-eight% of the 2647 patients (RA: n=1696, AS: n=445, PsA: n=376, SpA: n=130) were females and the median (inter-quartile range [IQR]) age and disease duration was 57.4 years (46.8–66.8) and 8.0 years (3.8–15.9), respectively. In total, 53.2% had indication for antiHT, and this was significantly higher in RA (57.0%) and PsA (57.2%). Among patients for whom antiHT was indicated, 59.0% received treatment (comparable across IJD entities) and half of the patients on antiHT had obtained BP goal. There was indication for LLT in 24.1%, which was comparable across the IJD entities except for AS (14.4%) (p Conclusions CVD-preventive medication is often indicated, but infrequently initiated in IJD patients. Moreover, when antiHT and LLT are started, quite few patients obtain treatment goals. There is a need for improving CVD risk assessment, initiation of proper CVD-prevention and careful monitoring of target achievements to successfully reduce the excess CVD risk in IJD patients. Disclosure of Interest None declared

Background EULAR recommendations for cardiovascular disease (CVD) risk management in inflammatory joint diseases (IJD) advocate annual CVD risk assessment. Knowledge of the most prevalent CVD risk factors in the different IJD diagnoses may enable tailoring of efficient CVD preventive strategies for these high risk patients. Objectives 1) Evaluate prevalence of CVD risk factors in IJD patients and estimate 10-year risk for fatal CVD using the Systemic COronary Risk Evaluation (SCORE). 2) Investigate possible differences in CVD risk factor distribution across IJD entities. Methods In the nationwide NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) project, annual CVD risk assessment is implemented in clinical practice of 11 rheumatology centres. IJD patients ≥30 years of age are eligible for inclusion. CVD risk factors and established CVD are recorded. The estimated CVD risk by SCORE was compared across IJD diagnoses for males and females individually, using analysis of variance, stratified by decennial age. Number of CVD risk factors, determined by presence of diabetes, hypertension, family history of premature CVD, hyperlipidemia (total cholesterol >8 mmol/L and/or low-density lipoprotein cholesterol >6 mmol/L), current smoking or obesity (body mass index ≥30kg/m 2 ), was counted for each patient. Frequency of CVD risk factors for the whole cohort was estimated and compared across the four major entities, using age and sex adjusted logistic regression analyses. Results Of the 2647 patients included in the 3 initial centres (Rheumatoid arthritis [RA]: n=1696, ankylosing spondylitis [AS]: n=445, psoriatic arthritis [PsA]: n=376, other spondyloarthritides [SpA]: n=130), 58.0% were females and the median (inter-quartile range [IQR]) age and disease duration were 57.4 (46.8–66.8) and 8.0 (3.8–15.9) years, respectively. The median (IQR) SCORE estimate was 1.4% (0.4–2.9) for the total population. The calculated CVD risk by SCORE was comparable across diagnoses, apart from male AS patients with a lower estimated CVD risk (p=0.01). Prevalence of CVD risk factors were comparable across all the IJD diagnoses, except for PsA patients who had significantly more CVD risk factors in the two oldest age groups (p=0.01). The percentage of patients with at least one CVD risk factor and the mean number of risk factors for each patient are presented in the Figure. In detail, CVD risk factor rates were: family history of premature CVD: 17.5%, established CVD: 9.8%, current smoking: 19.6%, hypertension: 53.2%, obesity: 17.9%, diabetes: 6.7% and hyperlipidemia: 1.3%. PsA patients were more obese (p=0.001), more often hyperlipidemics (p Conclusions In a large, multicentre cohort of IJD patients, a high prevalence of CVD risk factors was revealed, also in young patients. Interestingly, the risk factor burden was comparable in the 3 age categories across all IJD. Hence, CVD risk factor recording is essential in all IJD, and especially for PsA patients who had the largest CVD risk factor burden compared to the other IJD diagnoses. Disclosure of Interest None declared