Statin indication according to the 2019 World Health Organization cardiovascular disease risk charts and carotid ultrasound in Mexican mestizo rheumatoid arthritis patients

Abstract Background: We aimed to assess the concordance of recommendation for initiating statin therapy according to the 2019 World Health Organization (WHO) cardiovascular disease (CVD) risk charts and to the presence of carotid plaque (CP) identified with carotid ultrasound in Mexican mestizo rheumatoid arthritis (RA) patients, and to determine the proportion of patients reclassified to a high cardiovascular risk after the carotid ultrasound was performed. Methods: This was a cross-sectional study nested of a RA patients' cohort. A total of 157 Mexican mestizo RA patients were included. The cardiovascular evaluation was performed using the 2019 WHO CVD risk charts (laboratory-based model) for the Central Latin America region. A carotid ultrasound was performed in all patients. The indication to start statin therapy was considered if the patient was classified as high risk, moderate risk if > 40 years with total cholesterol (TC) > 200 mg/dl or LDL-C > 120 mg/dl, and low risk if > 40 years with TC > 300 mg/dl, according to the WHO CVD risk chart or if the patient had carotid plaque (CP). Cohen's kappa (k) coefficient was used to evaluate the concordance between statin therapy initiation. Results: Initiation of statin therapy was considered in 49 (31.2%) patients according to the 2019 WHO CVD risk charts and 49 (31.2%) patients by the presence of CP. Cardiovascular risk reclassification by the presence of CP was observed in 29 (18.9%) patients. A slight agreement (k = 0.140) was observed when comparing statin therapy recommendations between 2019 WHO CVD risk charts and the presence of CP. Conclusion: The WHO CVD risk charts failed to identify a large proportion of patients with subclinical atherosclerosis detected by the carotid ultrasound and the concordance between both methods was poor. Therefore, carotid ultra-sound should be considered in the cardiovascular evaluation of RA patients.

Manifestaciones reumatológicas en pacientes con infección por virus de la inmunodeficiencia humana / Rheumatic manifestations in AIDS

En el presente la infección por virus de la inmunodeficiencia humana (VIH) es considerada como una de las grandes mimetizadoras de otras enfermedades. Un número variable de hallazgos clínicos asociados con esta infección pueden ser descritos como afección autoinmune y/o reumática. Estos incluyen enfermedades del tejido conectivo (linfocitosis infiltrativa difusa, síndrome de Sjögren),síndromes articulares (sépticos, psoriásicos, Reiter), miopatías (por zidovudina, síndrome de desgaste, asociada a VIH, infecciones oportunistas), síndromes vasculíticos (necrotizante sistémica, hipersensibilidad, lesiones angiocéntricas inmuno-proliferativas) y alteración en estudios de laboratorio (anticuerpos anticardiolipina, anticuerpos anticelulares, anticuerpos antinucleares, complejos inmunes circulantes, hipergammaglobulinemia, factor reumatoide). El tratamiento de esta afección incluye terapia antiretroviral, esteroides, antinflamatorios no esteroideos y terapia inmunosupresora. La coexistencia de infección por VIH y enfermedad reumática ofrece nuevos conocimientos acerca de la patogénesis de ambas condiciones.