Background Rheumatoid Arthritis (RA) is associated with a higher cardiovascular mortality than the general population. Cardiovascular events prediction charts, as SCORE, due to its significant dependence on age, underestimate absolute cardiovascular risk (CVR) in young people. Although cardiovascular events usually appear at older ages, the presence of cardiovascular risk factors (CVRF) in middle aged people is highly predictive of both coronary morbidity and mortality.
Two methods exist to address this problem: a) Relative Cardiovascular Risk (RCR), which estimates the increased risk when compared to people of the same age without CVRF. b) Vascular Age, defined as the lower age with the same absolute CVR but no CVRF.
Objectives To evaluate the utility of the estimation of the RCR and the Vascular Age in patients with RA younger than 50 years.
Methods Transversal prospective study developed at the Rheumatology Services in two Spanish academic hospitals. Only patients under 50 years of age who fulfilled the EULAR/ACR 2010 criteria for RA were included. They were selected consecutively when they came for regular follow-up. To calculate SCORE, REGICOR, RCR and Vascular Age, we gathered the following variables: age, gender, tobacco habits, systolic blood pressure, total and HDL cholesterol serum levels and history of diabetes mellitus. According to the EULAR 2011 recommendations, a multiplying factor of 1.5 was applied to SCORE, REGICOR and RCR in patients who had at least two of the following criteria: a) Duration of RA >10 years, b) Positive RF or CCP, c) Presence of extraarticular manifestations. Data were included in an Access 2003 database and analyzed using SPPSS-Windows 15.
Results 140 patients with RA under 50 years of age were included [120 (86%) women] with an mean age of 40±7 years. 64% of patients had RF+ and 56%, CCP+. Regarding to the EULAR 2011 recommendations, 30% had RA duration >10 years, 71% had CCP or RF+, and 11% had extraarticular manifestations; 26% had 2 or more of the criteria. None of the patients had history of cardiovascular events.
The modified (after the application of the multiplying factor) mean SCORE was 1.03±0.52 and modified REGICOR 1.81±1.37. Mean RCR was 2.05±1.33, between 2x and 10x. 54% of the patients had a RCR superior to 1, and 47% had RCR between 2 and 3 times higher. Mean Vascular Age was 44±10 years, 4 years more than biological age. In 41% of the patients, Vascular Age was greater than biological age, from 3 to 20 years older. RCR identifies more patients with potential increased CVR than Vascular Age.
Patients with increased RCR were older (41±6 vs 38±9 years; p<0.01) and had a higher frequency of RA duration superior to 10 years (40% vs 7%, p<0.001) than the patients without.
Conclusions In young patients with Rheumatoid Arthritis, Relative Cardiovascular Risk and Vascular Age assessment are useful to identify patients with an increased cardiovascular risk who may remain unnoticed when estimated by the commonly recommended charts for the prediction of cardiovascular events.
Disclosure of Interest None declared