Suboptimal cardiovascular risk factor identification and management in patients with rheumatoid arthritis: a cohort analysis
Suboptimal cardiovascular risk factor identification and management in patients with rheumatoid arthritis: a cohort analysis
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DOI：
10.1186/ar4118
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发表时间：
2012-01-01
影响因子：
4.9
通讯作者：
Kaplan, Mariana J.
中科院分区：
文献类型：
--
作者：
Desai, Shailey S.;Myles, James D.;Kaplan, Mariana J.
导读：类风湿关节炎（RA）患者心血管（CV）疾病加速显著增加死亡率，其风险与2型糖尿病（DM）患者相当。类风湿性关节炎风险增加的部分原因是传统的心血管危险因素（CRFs）。本研究的目的是确定(a)风湿病学家与初级保健医生（pcp）在RA患者中识别和管理传统crf的频率；(b) RA、DM和普通人群（GP）患者的pcp。方法：一项回顾性队列研究比较了年龄/性别/种族匹配的三组患者：RA、DM和GP（无RA或DM）；每组N = 251例患者。在2007年6月至2011年4月连续12个月期间审查电子患者记录，以评估是否发现和管理crf。结果：在类风湿性关节炎患者中，pcp治疗肥胖、血压和血脂的频率明显高于风湿病学家。pcp在糖尿病患者中比在其他两组中更常用于控制肥胖、血压和血脂，在GP患者中比在RA患者中更常见。在BMI升高的患者中，68%的DM组、46%的GP组和31%的RA组的pcp控制了体重（所有组的P < 0.0001； RA组和GP组的P = 0.006）。结论：风湿病学家识别和处理crf的频率低于pcp。与全科医生和糖尿病患者相比，pcp治疗RA患者的crf频率较低。鉴于与RA相关的CV风险增加，医生需要更积极地治疗这些患者的crf。
Introduction: Accelerated cardiovascular (CV) disease significantly contributes to increased mortality in rheumatoid arthritis (RA) patients, with a risk comparable to the one observed in patients with type 2 diabetes mellitus (DM). Part of this enhanced risk in RA is attributed to traditional cardiovascular risk factors (CRFs). The aims of this study were to determine how often traditional CRFs are identified and managed by (a) rheumatologists, compared with primary care physicians (PCPs) in RA patients; and (b) PCPs among patients with RA, DM, and the general population (GP).Methods: A retrospective cohort study compared age/gender/ethnicity-matched patients from three groups: RA, DM, and GP (without RA or DM); n = 251 patients per group. Electronic patient records were reviewed during a continuous 12-month period between June 2007 and April 2011 to assess whether CRFs were identified and managed.Results: In RA patients, PCPs managed obesity, BP, and lipids significantly more often than did rheumatologists. PCPs managed obesity, BP, and lipids significantly more often in diabetic patients than in the other two groups, and more often in the GP than in RA patients. In patients with elevated BMI, PCPs managed weight in 68% of the DM group, 46% of the GP, and 31% of the RA group (P < 0.0001 for all groups; P = 0.006 between RA and GP groups).Conclusions: Rheumatologists identify and manage CRFs less frequently than PCPs. PCPs manage CRFs less frequently in RA patients, compared to the GP and DM. Given the increased CV risk associated with RA, physicians need to more aggressively manage CRFs in these patients.