Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country
Author
Solomon, Ahmed; Stanwix, Anne E.; Castañeda Sanz, Santos; Llorca, Javier; Gonzalez-Juanatey, Carlos; Hodkinson, Bridget; Romela, Benitha; Ally, Mahmood M.T.M.; Maharaj, Ajesh B.; Van Duuren, Elsa M.; Ziki, Joyce J.; Seboka, Mpoti; Mohapi, Makgotso; Jansen Van Rensburg, Barend J.; Tarr, Gareth S.; Makan, Kavita; Balton, Charlene; Gogakis, Aphrodite; González-Gay, Miguel A.; Dessein, Patrick H.Entity
UAM. Departamento de Medicina; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP)Publisher
BMCDate
2020-06-16Citation
10.1186/s41927-020-00139-2
BMC Rheumatology 4 (2020): 42
ISSN
2520-1026DOI
10.1186/s41927-020-00139-2Funded by
The first meeting held amongst local Rheumatologists was funded by the South African Arthritis and Rheumatology Association. The studies by Professor González-Gay have been supported by grants from “Fondo de Investigaciones Sanitarias” PI06/0024, PS09/00748, PI12/00060, PI15/00525, PI18/00043, and RD12/0009/0013 and RD16/0012 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain), co-funded by FEDER fundsEditor's Version
https://doi.org/10.1186/s41927-020-00139-2Subjects
Cardiovascular disease risk management; Low to middle income countries; Rheumatoid arthritis; South Africa; MedicinaRights
© 2020 The authorsAbstract
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.
Files in this item
Google Scholar:Solomon, Ahmed
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Stanwix, Anne E.
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Castañeda Sanz, Santos
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Llorca, Javier
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Gonzalez-Juanatey, Carlos
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Hodkinson, Bridget
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Romela, Benitha
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Ally, Mahmood M.T.M.
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Maharaj, Ajesh B.
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Van Duuren, Elsa M.
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Ziki, Joyce J.
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Seboka, Mpoti
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Mohapi, Makgotso
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Jansen Van Rensburg, Barend J.
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Tarr, Gareth S.
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Makan, Kavita
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Balton, Charlene
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Gogakis, Aphrodite
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González-Gay, Miguel A.
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Dessein, Patrick H.
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