Background Patients with rheumatoid arthritis (RA) have a well-established increased risk of cardiovascular disease (CVD). However, current CVD risk calculators for the general population (Framingham, SCORE, QRISK II and AHA/ACC) do not accurately predict CVD events in RA.
Objectives We compared the predicted risk of a future CVD event to the CVD event rate in RA patients.
Methods RA cohorts without prior CVD from 13 rheumatology centers were compared. CVD risk factors and RA characteristics were collected at baseline; CVD outcomes (myocardial infarction, angina, revascularization, CVD death, stroke and peripheral vascular disease) were collected prospectively. CVD risk was calculated for each patient based on baseline CVD risk factors and was converted to expected events. Poisson regression models provided standardized incidence ratios (SIR); observed to expected CVD. SIR<1 means lower CVD events than predicted by risk calculators.
Results 5685 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 76% female). During a mean follow-up of 6.1 years (31155 person years), 476 patients developed a CVD event. Two cohorts consisted of Hispanics, the rest Caucasians. RA disease duration varied by center: 4 with early RA (<1 year), 7 established RA (mean 9-13 years) RA and 2 with both. CVD event rates varied across countries (range 0.1-1.9%/year) with the lowest observed in Canada, Mexico and UK and the highest in US, Netherlands, and Sweden. SIR varied greatly between centers for Framingham (0.22-1.32) and AHA/ACC (0.31-1.58) and to a lesser extent for SCORE (0.12-0.80) and QRISK (0.18-1.16).
Conclusions Major heterogeneity exists in CVD event rates across different countries among patients with RA. Possible explanations include population differences, referral bias, RA treatment effects, statin and antihypertensive use. Generation of a CVD risk calculator that will be widely applicable for patients with RA must address these differences.
Acknowledgements The ATACC-RA consortium: S Gabriel, C Crowson, E Matteson, G Kitas, K Douglas, A Sandoo, AG Semb, S Rollefstad, E Ikdahl, P van Riel, E Arts, J Fransen, S Rantapää-Dahlqvist, S Wållberg-Jonsson, L Innala, G Karpouzas, P Sfikakis, E Zampeli, P Dessein, L Tsang, MA Gonzalez-Gay, A Corrales, H El-Gabalawy, C Hitchon, V Pascual Ramos, I Contreras Yáñez, D Solomon, K Liao, M van de Laar, H Vonkeman, I Meek, E Husni, R Overman, I Colunga, D Galarza
Disclosure of Interest None declared