Background Various cardiovascular risk calculators predict future risk of incident events in the general population; an estimated risk>10% is considered an “actionable” threshold for lifestyle and/ or pharmacologic intervention in the United States. The presence of coronary artery calcium (CAC>0), high plaque burden (segment stenosis score- SSS>5), and vulnerable plaque characteristics (low attenuation plaque, positive remodeling, spotty calcifications)- VP by coronary computed tomography angiography (CTA) may further optimize such risk predictions.
Objectives To evaluate the performance of various risk calculators in predicting all 3 aforementioned surrogate coronary outcomes in patients with Rheumatoid Arthritis (RA).
Methods One hundred and fifty RA subjects without symptoms or diagnosis of coronary artery disease underwent CTA; Qualitative and quantitative plaque evaluation was carried out using a standard 15- coronary segment American Heart Association Model. Cardiac risk scores were calculated using different iterations of Framingham (classic, NCEP-ATPIII, D’ Agostino), Reynolds, and QRISK2 calculators. An estimated risk threshold >10% was used to predict CAC>0, SSS>5 and VP presence using Fisher’s exact tests.
Results QRISK2 had the highest sensitivity (40%) in identifying RA subjects with actionable threshold, followed by D’Agostino (29.3%), classic Framingham and NCEP-ATPIII (both with 11.3%), and Reynold’s (2.7%). Risk score adjustment based on EULAR recommendations did not significantly alter the numbers of patients identified as actionable risk. Importantly, QRISK2 score >10% performed superiorly to other calculators in predicting presence of coronary calcification, high plaque burden, and plaque with vulnerability characteristics (table).
Conclusions QRISK2 most sensitively identifies RA subjects with >10% risk for future cardiovascular event; at this cut-off, it has the highest performance of all calculators tested in identifying presence of coronary calcification, high plaque burden and vulnerable plaque features.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.