Background Recently, a Spanish group[i] has proposed an algorithm that improves mSCORE estimation of cardiovascular risk (CVR) in patients with rheumatoid arthritis (RA), by adding the findings on carotid ultrasound (US).
Objectives To estimate CV risk in our RA patients by combining mSCORE and the findings on carotid US (intima-media thickness [IMT] and/or atherosclerotic plaques).
Methods A set of 188 patients with RA were assessed over a period of one year. Gender, age, duration of RA, extra-articular disease, smoking habit, blood pressure (BP), RF and/or anti-CCP antibodies +, and atherogenic index (AI) were collected. These data were used to calculate the SCORE and mSCORE. An ultrasound (US) examination was performed with an Esaote MyLab 70 US system equipped with a linear probe (7-12MHz) and an automated measurement of IMT by radiofrequency (QIMT). IMT was measured in bilateral common carotid, and the presence of atherosclerotic plaques was recorded in the extracranial carotid arteries according to Mannheim Consensus. Descriptive statistics were performed with the package SPSS 17.0.
Results 188 patients were evaluated, of whom 39 were excluded for high CVR (previous cardiovascular events, renal failure and/or diabetes mellitus). 75.8% were women, the mean age was 60.05 years, and 30.9% were smokers. The mean duration of RA was 17.37 years. Anti-CCP antibodies or FR positivity were found in 66.7% and 73%, respectively. The mean BP was 130.5/80.57mmHg, and the mean AI was 3.84. The average SCORE was 1.84 and mSCORE was 2.40. The percentage of patients classified as low CVR (mSCORE=0), moderate (1≤mSCORE<5), high and very high (mSCORE≥5) was 25.6% (n=32), 64% (n=80), and 10.4% (n=13), respectively. The mean IMT was 0.73mm, and 15.2% of the patients had an IMT>0.9mm. Plaques were found in 43.2% of patients. Patients with IMT>0.9mm and/or presence of plaque accounted for 45.5%. Following the recommendations1, 40 patients classified as moderate risk (52.6%) were reclassified as high risk by the presence of one or both carotid abnormalities. Only one patient with low risk had a pathological US examination. Our patients, compared with a population of northern Spain1, had less plaques and/or IMT>0.9mm, despite being an older population with a higher percentage of males and smokers, having a longer history of illness, a higher presence of extra-articular involvement, a worse AI, and a higher average mSCORE.
Conclusions Our results confirm that the CVR in RA patients is underestimated by the mSCORE and therefore, a carotid US examination is needed for the re-stratification of this risk. Compared with a population of northern Spain1, our patients have a lower vascular damage even though its clinical profile is theoretically less favorable from a CVR point of view. We could appeal to genetic or environmental factors such as diet to explain these differences.
Corrales A, et al. Ann Rheum Dis 2013 Mar 16[Epub ahead of print]
Disclosure of Interest None declared