Page 118 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

CHAPTER 6
Measurements
At baseline, patients were interviewed to record details about symptom history, disease history (special focus on CVD), clinical characteristics, demographics and medication use (including antihypertensives and statins).
At baseline and after four weeks, disease activity was measured with the Disease Activity Score of 44 joints (DAS44) and physical functioning by the Health Assessment Questionnaire (HAQ). Body mass index (BMI) was calculated from height and weight and blood pressure was measured manually according to the standard hospital procedures. Blood sample measurements at baseline were rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), and at baseline and four weeks: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and lipid profile, consisting of total cholesterol (TC), triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol.
Cardiovascular risk
CVD history was defined as an objectively confirmed by specialists history of coronary heart disease (myocardial infarction, angina pectoris, percutaneous coronary intervention and coronary artery bypass surgery, cerebral vascular disease and peripheral arterial disease). Patients with a CVD history were excluded from CV risk analyses. CV risk at baseline and after four weeks of treatment was retrospectively determined using the official online sites, according to two different risk scores: Dutch Systematic COronary Risk Evaluation (SCORE) and the European Heart SCORE(2;3). The Dutch SCORE risk model uses gender, age, smoking status, systolic blood pressure (SBP) and the TC:HDL ratio. To account for RA (or diabetes) as risk factor the Dutch CV-risk management (CV-RM) guideline adds 15 years to the actual age in order to calculate the 10-year CV risk. A risk<10% is classified as low, between 10% and 20% intermediate and a risk ≥20% as high risk. According to the Dutch CV-RM guideline, preventive treatment with an antihypertensive or statin is indicated in high risk patients with a SBP >140 mmHg or a LDL> 2.5 mmol/l, respectively(21). The European Heart SCORE risk model predicts the 10-year risk of a fatal heart attack, stroke or other circulatory problems in low risk regions of Europe by gender, age, SBP, TC:HDL ratio and smoking status. To calculate this Heart SCORE risk the results were multiplied with 1.5, which is suggested for RA patients in the updated EULAR 2015/2016 recommendations(8). The Heart SCORE considers a risk of <5% as low/medium, between 5 and 10% as high and ≥10% as very high. To be able to compare the Heart SCORE with the Dutch SCORE, we considered a Heart SCORE risk of <5% as low, a risk between 5 and 10% as medium and a risk ≥10% as high.
Statistical analyses
Patient characteristics were expressed as number (percentage), means ± standard deviation (SD), when normally distributed or median [interquartile range], when skewed distributed.
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