Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country
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...
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BMC
2020-06-01
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Series: | BMC Rheumatology |
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Online Access: | http://link.springer.com/article/10.1186/s41927-020-00139-2 |
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record_format |
Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
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 |
spellingShingle |
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 Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country BMC Rheumatology Cardiovascular disease risk management Rheumatoid arthritis Low to middle income countries South Africa |
author_facet |
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 |
author_sort |
Ahmed Solomon |
title |
Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country |
title_short |
Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country |
title_full |
Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country |
title_fullStr |
Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country |
title_full_unstemmed |
Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country |
title_sort |
points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in south africa, an unequal middle income country |
publisher |
BMC |
series |
BMC Rheumatology |
issn |
2520-1026 |
publishDate |
2020-06-01 |
description |
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. |
topic |
Cardiovascular disease risk management Rheumatoid arthritis Low to middle income countries South Africa |
url |
http://link.springer.com/article/10.1186/s41927-020-00139-2 |
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doaj-c93769aa79ee4d97abc50cc901e11eaf2020-11-25T03:02:44ZengBMCBMC Rheumatology2520-10262020-06-014111610.1186/s41927-020-00139-2Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income countryAhmed Solomon0Anne E. Stanwix1Santos Castañeda2Javier Llorca3Carlos Gonzalez-Juanatey4Bridget Hodkinson5Benitha Romela6Mahmood M. T. M. Ally7Ajesh B. Maharaj8Elsa M. Van Duuren9Joyce J. Ziki10Mpoti Seboka11Makgotso Mohapi12Barend J. Jansen Van Rensburg13Gareth S. Tarr14Kavita Makan15Charlene Balton16Aphrodite Gogakis17Miguel A. González-Gay18Patrick H. Dessein19Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of WitwatersrandRheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of WitwatersrandRheumatology Department, Hospital de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM)Universidad de Cantabria – IDIVAL, CIBER Epidemiologia y Salud Pública (CIBERESP)Cardiology Department, University Hospital Lucus AugustiRheumatology Department, University of Cape Town and Groote Schuur HospitalRheumatology Unit, Wilgeheuwel HospitalRheumatology Department, Steve Biko Academic Hospital, University of PretoriaRheumatology Unit, Westville Hospital and University of KwaZulu-NatalRheumatology Division, Department of Medicine, Sefako Makgatho Health Sciences UniversityRheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of WitwatersrandRheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of WitwatersrandRheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of WitwatersrandRheumatology Department, Universitas HospitalRheumatology Department, Tygerberg Hospital, Faculty of Health Sciences, Physiological Sciences Department, Stellenbosch UniversityRheumatology Department, Chris Hani Baragwanath HospitalRheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of WitwatersrandRadiology Unit, Rivonia Road Medical CentreCardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of WitwatersrandRheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of WitwatersrandAbstract 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.http://link.springer.com/article/10.1186/s41927-020-00139-2Cardiovascular disease risk managementRheumatoid arthritisLow to middle income countriesSouth Africa |