Article Text

PDF
OP0257 Rheumatoid Arthritis-Specific Cardiovascular Risk Calculators Are Not Superior To Risk Calculators Established for The General Population: A Validation Analysis in A Cohort of RA Patients from 7 Countries
  1. C.S. Crowson1,
  2. S.E. Gabriel2,
  3. A.G. Semb3,
  4. P.L. van Riel4,
  5. G. Karpouzas5,
  6. P.H. Dessein6,
  7. C. Hitchon7,
  8. V. Pascual Ramos8,
  9. G.D. Kitas9,
  10. on behalf of A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA)
  1. 1Mayo Clinic, Rochester, MN
  2. 2Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
  3. 3Diakonhjemmet Hospital, Oslo, Norway
  4. 4Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
  5. 5Harbor UCLA Medical Center RHU, torrance, CA, United States
  6. 6Witwatersrand University, Johannesburg, South Africa
  7. 7University of Manitoba, Winnipeg, Manitoba, Canada
  8. 8Instituto Nacional de Ciencias Médicas y Nutriciόn Salvador Zubir, México City, Mexico
  9. 9Dudley Group NHS Foundation Trust, West Midlands, United Kingdom

Abstract

Background Cardiovascular disease (CVD) risk calculators developed for the general population do not accurately predict CVD events in patients with rheumatoid arthritis (RA).

Objectives To externally validate risk calculators recommended for use in patients with RA including the European League Against Rheumatism (EULAR) 1.5 multiplier, the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) and QRISK2.

Methods Seven RA cohorts from United Kingdom, Norway, Netherlands, United States, South Africa, Canada and Mexico were combined. Data on baseline CVD risk factors, RA characteristics and CVD outcomes (including myocardial infarction, ischemic stroke and cardiovascular death) were collected using standardized definitions. Performance of QRISK2, EULAR multiplier and ERS-RA was compared to other risk calculators (ACC/AHA, Framingham Adult Treatment Panel III [FRS-ATP] and Reynolds Risk Score) using c-statistics and net reclassification index (NRI).

Results Among 1796 RA patients without prior CVD (mean age: 54.0 [SD: 14.0] years, 74% female), 100 developed CVD events during a mean follow-up of 6.9 years (12430 person-years). Estimated CVD risk by ERS-RA (mean: 8.8%, SD: 9.8%) was comparable to FRS-ATP (mean: 9.1%, SD:8.3%) and Reynolds (mean: 9.2%, SD: 12.2%), but lower than ACC/AHA (mean: 9.8%, SD: 12.1%) and QRISK2 (mean: 15.5%, SD: 13.9%) estimates. Discrimination was not improved for ERS-RA (c-statistic=0.69), QRISK2 or EULAR multiplier applied to FRS-ATP and ACC/AHA (c-statistic=0.72 for all) compared to ACC/AHA and FRS-ATP (c-statistic=0.72 for both). The NRI for ERS-RA were low (-0.8% vs. ACC/AHA and 2.3% vs. FRS-ATP). The NRI for QRISK2 compared ACC/AHA was low (-2.4%). The NRI for QRISK2 compared to FRS-ATP was higher, but not significant (NRI: 25.0%, 95% CI: -9.4–34.7%). The EULAR multiplier only reclassified 6 patients above the 7.5% treatment threshold for the ACC/AHA calculator and 3 patients above the 20% treatment threshold for the FRS-ATP calculator, so the NRI was negligible.

Conclusions The QRISK2, EULAR multiplier and ERS-RA algorithms did not predict CVD risk more accurately in patients with RA than CVD risk calculators developed for the general population.

Acknowledgement The ATACC-RA consortium: S Gabriel, C Crowson, E Matteson, G Kitas, K Douglas, A Sandoo, AG Semb, S Rollefstad, E Ikdahl, T Kvien, 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, M van de Laar, H Vonkeman, I Meek, E Husni, R Overman, I Colunga, D Galarza

Disclosure of Interest None declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.