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Original article
Cardiovascular risk assessment and treatment in chronic inflammatory disorders in primary care
  1. G Emanuel1,
  2. J Charlton1,
  3. M Ashworth1,
  4. M C Gulliford1,2,
  5. A Dregan1,2
  1. 1Department of Primary Care and Public Health, King's College London, London, UK
  2. 2National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas’ National Health Service Foundation Trust, Kings’ College London, London UK
  1. Correspondence to Dr A Dregan, Department of Primary Care and Public Health, 5th Floor, Addison House, Guy's Campus, London SE1 1UL, UK; alexandru.dregan{at}kcl.ac.uk

Abstract

Objective To compare differences in cardiovascular (CV) risk factors assessment and management among patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) with that of matched controls.

Methods A matched cohort study was conducted using primary care electronic health records for one London borough. All patients diagnosed with RA or IBD, and matched controls registered with local general practices on 12th of January 2014 were identified. The study compared assessment and treatment of CV risk factors (blood pressure, body mass index, cholesterol and smoking) in the year before, the year after, and 5 years after RA and IBD diagnosis.

Results A total of 1121 patients with RA and 1875 patients with IBD were identified and matched with 4282 and, respectively, 7803 controls. Patients with RA were 25% (incidence rate ratio, 1.25, 95% CI 1.12 to 1.35) more likely to have a CV risk factor measured compared with matched controls. The difference declined to 8% (1.08, 1.04 to 1.14) over 5 years of follow-up. The corresponding figures for IBD were 26% (1.26, 1.16 to 1.38) and 10% (1.10, 1.05 to 1.15). Patients with RA showed higher antihypertensive prescription rates during 5 years of follow-up (OR, 1.37, 95% CI 1.14 to 1.65) and patients with IBD showed higher statin prescription rates in the year preceding diagnosis (2.30, 1.20 to 4.42). Incomplete CV risk assessment meant that QRISK scores could be calculated for less than a fifth (17%) and clinical recording of CV disease (CVD) risk scores among patients with RA and IBD was 11% and 6%, respectively.

Conclusions The assessment and treatment of vascular risk in patients with RA and IBD in primary care is suboptimal, particularly with reference to CVD risk score calculation.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors All listed authors have contributed significantly to the research and manuscript. EG, MA, MCG and AD are responsible for the conception and design of the study. AD and EG are responsible for data interpretation, drafting the manuscript and overall quality of the work. EG, JC and AD are responsible for data analysis and data interpretation. MA has provided access to the data. All authors have provided critical comments to the manuscript and they all have approved the final version of the manuscript. All authors are accountable for all aspects of the work and for the integrity of the research.

  • Funding AD and MCG are supported by the National Institute for Health Research Biomedical Research Center at Guy's and St Thomas' National Health Service Foundation Trust and King's College London.

  • Competing interests None declared.

  • Ethical approval The data, anonymised prior to being received for this analysis, was defined by the South London Primary Care Research Governance Team, St George's Hospital Medical School, London, as audit style and therefore not requiring research governance or ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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