AB0327 CARDIOVASCULAR RISK ASSESSMENT IN RHEUMATOID ARTHRITIS WITH CAROTID ULTRASONOGRAPHY AND CARDIOVASCULAR RISK SCORES: A CASE CONTROL STUDY

Abstract

BackgroundThe risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than individuals from the general population. This excess risk might be explained by the chronic inflammation.ObjectivesTo assess the Cardiovascular Risk (CV) in Rheumatoid Arthritis (RA) patients using the Framingham Score, SCORE (systematic coronary risk evaluation) and carotid ultrasound additionally to the traditional cardiovascular risk factors.MethodsA single center case control study was performed. Inclusion criteria were adult RA patients (cases) and matched healthy adults in terms of age, sex, and CV risk factors (controls). Population over 75 years old, patients with established CV disease and/or stage III chronic kidney disease were excluded. Controls with other inflammatory diseases, pregnant women or any malignancy were also excluded. This study was performed from July-2019 to January-2020. The US study included presence of plaques, plaque number and measurement the intima-media thickness in both right and left carotid. Scores were multiplicated x1.5 according to EULAR recommendations.ResultsOverall, a total of 200 cases and 111 healthy controls were included in the study. Demographical and clinical variables were comparable between cases and controls and are shown in Table 1. In both groups a relationship between age, BMI and high blood pressure was detected (p<0.001). RA patients had a Disease duration of 18.93 years (11.36); 163 (81.5%) Erosions (X-Ray of hands/feet), Extra-articular symptoms 44 (22%), Prednisone use 103 (51.5%) with Median dose of Prednisone last year 2.34 (2.84). In treatment with Methotrexate 104 (52%), bDMARDs 89 (44.5%) and JAK inhibitor 26 (13%). US study revealed a higher IMT in both right and left carotid arteries with greater presence of plaques in patients than in controls (CI 95% [1.542; 3.436], p<0.001). Plaques were found in both carotid arteries in the 32% of cases and 9.91% of controls. The longer duration of RA was related to a higher presence of carotid plaques (95% [1.015; 1.056], p<0.001). US and blood test results are shown in Table 3. SCORE and Framingham correlated with the CV estimation with US (p<0.001), however, seemed to underestimate the global findings in cases (p<0.001).Table 1.Demographic, clinical characteristics, Ultrasound Results, SCORE and Framingham of patients and controls.CharacteristicRA cases n=200Healthy controls n=111Age - years62.05 (10.75)58.3 (12.14)Female sex – number (%)163 (81.5)73 (65.77)BMI – value (ds)26.38 (5.03)26.2 (5.19)Smoking habitNever Smoked107 (53.5%)71 (63.96%)Ex-smoker51 (25.5%)20 (18.02%)Active smoker42 (21%)20 (18.2%)Race – number (%)Caucasian186 (93)62 (93.94)Comorbidities – number (%)High blood pressure83 (41.5%)34 (30.63%)Dyslipemia93 (46.5%)39 (35.14%)Blood pressure -- mmHg127.2(18.36)/78.67(10.21)127.77(19.42)/78.28 (10.59)Ultrasound findingsRight carotid cIMT0.78 (0.15)0.62 (0.11)Left carotid cIMT0.77 (0.14)0.64 (0.12)Plaques101 (50.5%)32 (28.83%)Bilateral64 (32%)11 (9.91%)Right carotid17 (8.5%)7 (6.31%)Left carotid20 (10%)14 (12.61%)SCOREVery Hihg13 (6.5%)5 (4.5%)High31 (15.5%)15 (13.51%)Low156 (78%)91 (81.98%)FraminghamHigh76 (38%)33 (29.7%)Low124 (62%)78 (70.3%)ConclusionCardiovascular risk calculators such as Framingham and SCORE are useful in RA risk estimation. However, those tools may underestimate the real risk, so carotid US might be valuable.Disclosure of InterestsNone declared