Background In patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA), but without manifest cardiovascular disease (CVD) or diabetes mellitus (DM), individual cardiovascular risk (CVR) should be estimated according to the SCORE-algorithm [1,2] and the EULAR recommendations for CVR-management . A 10-year risk of fatal cardiovascular disease of >10% (“high 10yCVR”) is often used as threshold for special therapeutic interventions such as statin therapy.
Objectives To evaluate CVR in patients with RA or SpA in a rheumatological outpatient department, and to define groups of patients with high probability for a high 10yCVR, on which CVR-assessment can be focused in routine rheumatological care.
Methods In 352 consecutive patients >40 years of age with RA (274) or SpA (78), but without manifest CVD or DM, CVR was estimated according to the SCORE-algorithm based on age, gender, smoking status, lipid status, blood pressure, duration of disease and RF/CCP-antibody-status. On the basis of the distribution of these probabilities in domains characterized by gender, age and smoking status, subgroups of patients with preferably high sensitivity to cover the patients with high 10yCVR were defined.
Results From 99 patients in the age between 40 and 55 years nobody had a 10yCVR>10%. The prevalence of a high 10yCVR in patients older than 55 y. was 18,6% (47/253). Most of these high-risk patients were older than 65 years. Limiting CVR-assessment to the age-group older than 65 years showed a sensitivity of 87,2% (41/47) for the identification of patients with high 10yCVR (together with a specificity of 51,0% in the group of patients older than 55 y.). A higher sensitivity could be reached with a more differentiated strategy only using the basic criteria gender, age and smoking status by the restriction of detailed CVR-assessment to women >65 y. and to men >60 y. (male smoker >55 y.). This strategy had a sensitivity of 100% and a specificity of 41,7% for the identification of rheumatic patients with high 10yCVR in the group older than 55 y.
Conclusions In routine rheumatological care detailed CVR-assessment by SCORE algorithm can be limited to a predefined group of RA and SpA patients. Easy to implement preselection strategies are: A) to assess10yCVR only in patients older than 65 years B) to assess 10yCVR only in women >65 years and men >60 years (male smoker >55 years) In our study group both strategies had a high sensitivity (A 87%, B 100%) for the identification of patients with a 10yCVR of at least 10%.
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Disclosure of Interest None declared
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