Abstract
Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ultrasound, has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who had been included in the low or moderate CVD risk categories when the SCORE risk tables were applied. The 2003 SCORE calculator was recently updated to a new prediction model: SCORE2. This new algorithm improves the identification of individuals from the general population at high risk of developing CVD in Europe. Our objective was to compare the predictive capacity between the original SCORE and the new SCORE2 to identify RA patients with subclinical atherosclerosis and, consequently, high risk of CVD. 1168 non-diabetic patients with RA and age > 40 years were recruited. Subclinical atherosclerosis was searched for by carotid ultrasound. The presence of carotid plaque and the carotid intima media wall thickness (cIMT) were evaluated. SCORE and SCORE2 were also calculated. The relationships of SCORE and SCORE2 to each other and to the presence of subclinical carotid atherosclerosis were studied. The correlation between SCORE and SCORE2 was found to be high in patients with RA (Spearman’s Rho = 0.961, p < 0.001). Both SCORE (Spearman’s Rho = 0.524) and SCORE2 (Spearman’s Rho = 0.521) were similarly correlated with cIMT (p = 0.92). Likewise, both calculators showed significant and comparable discriminations for the presence of carotid plaque: SCORE AUC 0.781 (95%CI 0.755–0.807) and SCORE2 AUC 0.774 (95%CI 0.748–0.801). Using SCORE, 80% and 20% of the patients were in the low or moderate and high or very high CVD risk categories, respectively. However, when the same categories were evaluated using SCORE2, the percentages were different (58% and 42%, respectively). Consequently, the number of RA patients included in the high or very high CVD risk categories was significantly higher with SCORE2 compared to the original SCORE. (p < 0.001). In conclusion, although predictive capacity for the presence of carotid plaque is equivalent between SCORE and SCORE2, SCORE2 identifies a significantly higher proportion of patients with RA who are at high or very high risk of CVD.
Highlights
Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular (CV)disease [1]
It was determined that the presence of subclinical atherosclerosis identified by the presence of carotid plaque using carotid ultrasound predicted the development of CV events and death in patients with RA [4]
Such was the case for the Systematic Coronary Risk Assessment (SCORE) [5], which was originally developed for use in the general European population in 2003 and relied heavily on traditional CV disease risk factors
Summary
Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular (CV)disease [1]. Risk chart algorithms often underestimate the risk of CV disease in patients with RA Such was the case for the Systematic Coronary Risk Assessment (SCORE) [5], which was originally developed for use in the general European population in 2003 and relied heavily on traditional CV disease risk factors. In this sense, the use of noninvasive surrogate markers such as the carotid ultrasound has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who were included in the low or moderate CVD risk categories when the SCORE risk tables were applied [6]. Additional studies have confirmed the suboptimal performance of the SCORE algorithm to identify patients with RA at high risk of CVD disease [7]
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