Marked underdiagnosis and undertreatment of hypertension and hypercholesterolaemia in rheumatoid arthritis

Rheumatology (Oxford). 2016 Jul;55(7):1210-6. doi: 10.1093/rheumatology/kew039. Epub 2016 Mar 23.


Objective: To investigate the prevalence of underdiagnosis and undertreatment of traditional cardiovascular risk factors in RA patients.

Methods: RA patients ⩽70 years of age without cardiovascular disease (CVD) or diabetes mellitus were included. Systolic blood pressure and a fasting lipid profile were measured. The 10-year CVD risk was estimated using the Dutch Cardiovascular Risk Management (CVRM) guideline and EULAR modifications of the Systemic Coronary Risk Evaluation tables.

Results: A total of 327 patients were included (female gender: 68%). The mean age was 53 (11) years [mean (s.d.)]. The median disease duration was 7 years (inter quartile range: 2-14 years). According to the CVRM guideline, 52% of the patients had a CVD risk ⩾20% and according to the EULAR guidelines, 18% of the patients had a CVD risk ≥ 20%. Low-density lipoprotein cholesterol (LDL-C) >2.5 mmol/l was found in >80% of the patients with a CVD risk ⩾10% as estimated by both the CVRM and EULAR guidelines, and 32-42% of the patients with a CVD risk ⩾10% had a systolic blood pressure >140 mmHg, depending on the risk model used. Statins were used in 6% and antihypertensives in 23-25%, and 50-86% of these patients did not reach the recommended treatment targets.

Conclusion: Regardless of the adapted risk assessment model used, untreated hypertension and hypercholesterolaemia were frequently found in RA patients with increased CVD risk. Treatment of these cardiovascular risk factors deserves more attention in RA.

Trial registration: The Dutch Trial Register,, NTR3873.

Keywords: cardiovascular risk; rheumatoid arthritis; risk assessment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antihypertensive Agents / therapeutic use
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / complications*
  • Arthritis, Rheumatoid / physiopathology
  • Blood Pressure
  • C-Reactive Protein / analysis
  • Cholesterol, LDL / blood
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypercholesterolemia / diagnosis
  • Hypercholesterolemia / drug therapy
  • Hypercholesterolemia / epidemiology*
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / epidemiology*
  • Male
  • Middle Aged
  • Prevalence
  • Risk Assessment / methods
  • Risk Factors


  • Antihypertensive Agents
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • C-Reactive Protein