Background Individuals with inflammatory joint diseases (IJD) [rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA)] have increased risk of cardiovascular disease (CVD). In the European guidelines for CVD prevention, calculation of relative risk and risk age is advised in patients with low absolute risk of fatal CVD events the next 10 years estimated by the systematic coronary risk evaluation [SCORE] algorithm; the rational being that low absolute risk may conceal high relative risk and risk ages far beyond chronological age. Thus, more patients needing intensive CVD prevention may be identified.
Relative risk is a ratio comparing absolute CVD risk in a specific patient to the risk given optimal CVD risk factor levels (CVDRFs). Risk age denotes the age with similar CVD risk and optimal CVDRFs. To this date, no studies have evaluated relative risk and risk age across IJD entities, neither has the agreement between different risk age models been investigated.
Objectives 1) Estimate relative risk and risk age across IJD entities. 2) Investigate agreement between different risk age models.
Methods RA/axSpA/PsA patients aged 40≤65 years with low/moderate 10-year risk of fatal CVD were included from a nationwide quality assurance project implementing CVD risk assessment. Relative risk and cardiovascular risk age was calculated in accordance with risk charts published by the European Society of Cardiology (2016) and Cooney et al (2012), respectively. Vascular age was calculated by matching SCORE to estimated risk ages in accordance with Cuende et al (2010). Four different vascular age estimations were calculated, depending on whether the EULAR 1.5 multiplication factor in RA was applied (mSCORE) and if SCORE version with HDL-c (SCORE-HDL-c) was used: SCORE, SCORE-HDL-c, mSCORE and mSCORE-HDL-c. Risk years beyond chronologic age, were calculated. Linear regression models were used to investigate agreement between risk age estimations.
Results Relative risk was increased in 53% of all patients and 20% had three times the risk or higher compared to individuals with optimal CVDRF levels. In total, 42% and 20% had a risk age ≥5 years higher than their chronologic age, according to the cardiovascular risk age model and the vascular age model derived from SCORE, respectively. There were minor differences between RA, axSpA and PsA patients in terms of relative risk and risk age. Agreement between cardiovascular risk age and various vascular age models varied (Figure). Discrepancies ≥5 years in estimated risk age were observed in 14–43% of estimations. The largest observed difference in calculated risk age was 24 years. Similarly, linear regression models yielded a R2 of 0.81–0.96. Across all models, median difference between risk age and age increased with advancing relative risk. Moreover, several patients had high relative risk despite a risk age close to their chronologic age.
Conclusions Relative risk and risk age may identify several patients at high need of intensive CVD preventive efforts despite low estimated absolute risk. However, there are considerable discrepancies between risk age models.
Disclosure of Interest None declared