Avaliação do risco cardiovascular em portadores de artrite reumatoide: prevalência e fatores associados

Abstract

Introduction: Rheumatoid arthritis is a chronic inflammatory systemic disease related to high mortality rate, especially due to cardiovascular complications. There are no specific formulas available to estimate this population’s cardiovascular risk. Elevated C-reactive protein (CRP) levels are related to a higher risk of cardiovascular events within this group. The Framingham risk score, which is widely applied in clinical practice, was validated to these patients. Objective: To assess the high-risk prevalence in cardiovascular events through Framingham risk score. To assess factors related to increased cardiovascular risk. Methods: Observational, transversal and analytical epidemiologic study for data collection. The study was carried out with a sample of 103 patients assisted at the Rheumatology medical clinic of the Regional Hospital of Taguatinga (HRT), from March to December 2018. Data collection was performed through interviews, questionnaire, clinical test with anthropometric data and lab tests (lipid profile, ESR and CRP, microalbuminuria in isolated urine, anti-CCP). Furthermore, the Framingham Score was applied. Uni and multivariate logistic regressions were executed for data collection. Results: Out of 103 analyzed patients the mean age was 55.77 ± 11.13 years and the diagnosis time was 11.0 (5 - 20) years. Most patients were female (88.3%), with positive rheumatoid factor (92.2%) and anti-CCP positive (74.8%). Most cases have preserved renal function (92.2%), no microalbuminuria (94.2%) and deny smoking (79.6%). Only 17 (16.5%) were classified as Framingham high risk and with a chance of increasing 3.65 times an individual with positive CRP, presenting high risk in relation to the variables with negative CRP. An increase of one year in age, a chance of being classified as Framingham increases the risk by 1,109 times. Regarding DAS-28, 50.5% were in remission of the disease. The presence of microalbuminuria was observed in 6 patients (5.8%) and only with values greater than 300mg/g. There was no association between disease activity, renal function and comorbidities to cardiovascular risk increase. Conclusion: The prevalence of cardiovascular high risk according to the Framingham score in rheumatoid arthritis patients was of 16.5%. CRP positive patients presented greater risk of high Framingham when compared to those of negative CRP. It was observed a greater cardiovascular risk related to increase in age, systemic blood pressure and weight.