Article Text

THU0045 Score and framingham predict cv disease incidence in RA patients better than intima-media thickness
  1. A.M. van Sijl1,2,3,
  2. I.A. van den Oever4,
  3. H.G. Raterman1,2,
  4. M.J. Peters3,
  5. V.P. van Halm5,
  6. M. Boers6,
  7. Y.M. Smulders3,
  8. A.E. Voskuyl2,
  9. M.T. Nurmohamed2,3,4
  1. 1Rheumatology, Reade, Jan Van Breemen Research Institute - Reade
  2. 2Rheumatology, VU University Medical Center
  3. 3Internal medicine, Institute for Cardiovascular Research (ICaR), VU University Medical Center
  4. 4Rheumatology, Jan Van Breemen Research Institute - Reade
  5. 5Cardiology, Academic Medical Center
  6. 6Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands


Background Rheumatoid arthritis (RA) is a chronic inflammatory disease with an increased cardiovascular (CV) risk. Carotid intima-media thickness (cIMT) predicts CV events in the general population, and hence, is used as a non-invasive screening tool to identify patients at high CV risk. In RA, it is still unclear whether estimated 10-year CV risk models, such as the Systematic Coronary Risk Evaluation (SCORE) and Framingham accurately predict CV disease incidence or whether cIMT measurement can equally predict CV disease incidence.

Objectives To investigate the predictive value of SCORE- and Framingham risk models and cIMT for future CV events in RA.

Methods CARRΈ is an ongoing cohort study of CV disease in RA. In a subpopulation (n=141) we measured cIMT at baseline; Of those, 120 had no prior CV disease and 10-year risk of fatal and nonfatal CV disease was calculated. We compared these calculations with actual CV events recorded in a mean follow-up of 9 years. During this time, IMT was measured three times. Univariate logistic regression analyses (with standardized odds ratios) investigated the extent to which individual CV risk factors, SCORE, Framingham and cIMT predicted CV disease incidence.

Results Thirteen RA patients (incidence rate: 13.5%, 95% confidence interval (CI): 7.8-23.2) developed a CV event, of which four of these events were fatal (incidence rate: 4.2%, 95%>CI: 1.6-11.1). SCORE- and Framingham predictions were very close to actual CV mortality and morbidity and significantly predicted (fatal) CV events. cIMT also showed a trend in prediction of CV disease. cIMT progressed with an annual rate of 0.005mm.

Table 1. Logistic regression of CV disease incidence with CV risk factors, IMT and CV risk models

Conclusions This long term follow up study underscores the value of SCORE and Framingham in prediction of CV disease incidence, also in RA. In this study of RA patients the evidence for cIMT, a surrogate marker of CV disease in the general population, had no predictive value.

Disclosure of Interest None Declared

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