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Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country

Authors :
Ahmed Solomon
Anne E. Stanwix
Santos Castañeda
Javier Llorca
Carlos Gonzalez-Juanatey
Bridget Hodkinson
Benitha Romela
Mahmood M. T. M. Ally
Ajesh B. Maharaj
Elsa M. Van Duuren
Joyce J. Ziki
Mpoti Seboka
Makgotso Mohapi
Barend J. Jansen Van Rensburg
Gareth S. Tarr
Kavita Makan
Charlene Balton
Aphrodite Gogakis
Miguel A. González-Gay
Patrick H. Dessein
Source :
BMC Rheumatology, Vol 4, Iss 1, Pp 1-16 (2020)
Publication Year :
2020
Publisher :
BMC, 2020.

Abstract

Abstract Background It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.

Details

Language :
English
ISSN :
25201026
Volume :
4
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Rheumatology
Publication Type :
Academic Journal
Accession number :
edsdoj.93769aa79ee4d97abc50cc901e11eaf
Document Type :
article
Full Text :
https://doi.org/10.1186/s41927-020-00139-2