Background The main cause of mortality in rheumatoid arthritis (RA) are the cardiovascular (CV) events. This is directly related to the chronic inflammatory state. Although stratification by SCOREm proposed by EULAR is an important advance, it may not properly correlate with the process of subclinical atherosclerosis by carotid ultrasound (EC) in this group of patients.
Objectives To determine the cardiovascular risk in patients with rheumatoid arthritis and correlation with subclinical atherosclerosis by EC.
Methods An observational, descriptive study was made in the Rheumatology deparment of the general hospital of Ciudad Real (GHCR) during June 2013 - May 2014. CV risk assessment was performed according to the results of SCOREm, dividing the population into low-risk and not low-risk (medium, high and very high). Carotid ultrasound was performed in low-risk group and a random sample of not low-risk group. Finally, the results were correlated.
Results Preliminary results are presented (June - November 2013) with a total of 44 patients (52.27% female) with a mean age of 56.42 years. 8 (18.18%) patients had no traditional CV factors, 10 (22.72%), diabetes mellitus, 7 (15.9%) microalbuminuria, 6 (13.63%) renal dysfunction and 8 (18.18%) a previous CV event. The mean disease duration was 12.24 years, rheumatoid factor was positive in 50% and anti -CCP in 70.45%, only 9 (20.45%) had extra- articular manifestations. CVR to 10 years was determined according to EULAR SCOREm obtaining 21 patients with low risk (47.72%). The mean carotid intima-media thickness (cIMT) in low-risk group was 0.6683mm and in the not low risk group was 0.865mm, with an OR of 24 (95%CI: 3.33-172.70 to cIMT > or =0.8mm in those were classified as not low risk. Moreover, the presence of atheromatous plaques was detected in 14.28% of patients classified as low risk and the 21.73% of those not low risk, with an OR of 2.89 (95%CI:0.93 -8.98) is being not statistically significant difference between the two groups, so the SCOREm not discriminate adequately the cardiovascular risk according to carotid atherosclerosis.
Conclusions Although the information presented is a preliminary results, we have observed atherosclerotic plaques in low-risk group by SCOREm and the mean cIMT in this group was higher than the general healthy population (normal cIMT for age and sex: 0.6661mm). So, we can conclude that there would be no correlation between risk stratification by SCOREm and the presence of subclinical atherosclerosis. Therefore, we should recommend performing carotid ultrasound in patients with rheumatoid arthritis with low/medium CVR because their re-categorization to high/very high CV risk would modify the strategy to cardiovascular prevention.
González-Gay MA, González-Juanatey C, Llorca J. Carotid ultrasound in the cardiovascular risk stratification of patients with rheumatoid arthritis:when and for whom? Ann Rheum Dis 2012; 71: 796-798.
Corrales A, Gonzalez-Juanatey C, Peirό ME, Blanco R, Llorca J et al. Carotid ultrasound is useful for the cardiovascular risk stratification of patients with rheumatoid arthritis: results of a population-based study. Ann Rheum Dis. 2013 (Online).
Disclosure of Interest None declared