Background Rheumatoid arthritis (RA) is associated with accelerated atherosclerosis and increased cardiovascular risk (CVR). There is no specific CVR score in RA population. Scores developed for general population inaccurately estimate this risk. Carotid intima-media thickness (CIMT) measurement by ultrasound (US) is a non-invasive method that identifies subclinical atherosclerosis and strongly predicts future cardiovascular disease.
Objectives Correlate carotid intima-media thickness and the result of 4 different risk scores (Framingham lipids, Framigham BMI, QRisk II, and Omnibus 2013 ACC/AHA cardiovascular risk score) in a cohort of patients with RA.
Methods Observational, cross-sectional study based on a cohort of 87 Mexican Mestizo patients with RA who fulfilled the 1987/ 2010 ACR classification criteria who attended our referral center. Clinical assessment of cardiovascular comorbidities, disease activity, anthropometry, lipid profiles, and carotid Doppler US for measurement of intima-media thickness and plaque were performed. Simple bivariate correlations for cardiovascular risk by the 4 models were analyzed against CIMT by Spearman's correlation coefficient. To determine difference between each of the correlations, bivariate correlations comparison was performed by Steiger's Z-test.
Results 87 patients were included in the analysis. Demographic characteristics and correlations are shown on Table 1. Plaque was recorded in 38 patients (43.67%). CIMT median was 0.08cm (IQR 0.07-0.09). A positive correlation was found between all CVR scores evaluated and CIMT (p<.01). All of the correlations showed no statistically significant difference between themselves.
Conclusions All 4 scales positively correlated with CIMT. QRisk II incorporates RA into its CVR calculation and showed a trend toward a better performance than the other 3 scales, although this difference was not statistically significant. A specific CVR score designed for RA patients could improve the prediction of subclinical atherosclerosis and cardiovascular disease in this population.
Arts EE, Popa C, Den Broeder AA, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis 2014; 0:1-7.
Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007;115:459-67.
Disclosure of Interest None declared