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Cardiovascular risk stratification in rheumatic diseases: carotid ultrasound is more sensitive than Coronary Artery Calcification Score to detect subclinical atherosclerosis in patients with rheumatoid arthritis
  1. Alfonso Corrales1,
  2. José A Parra2,
  3. Carlos González-Juanatey3,
  4. Javier Rueda-Gotor1,
  5. Ricardo Blanco1,
  6. Javier Llorca4,
  7. Miguel A González-Gay1
  1. 1Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
  2. 2Division of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
  3. 3Division of Cardiology, Hospital Lucus Augusti, Lugo, Cantabria, Spain
  4. 4Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Cantabria, Spain
  1. Correspondence to Dr Miguel A González-Gay, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IFIMAV, Avenida de Valdecilla, s/n, 39008, Santander, Cantabria 39008, Spain; miguelaggay{at}


Objective To determine the ability of Coronary Artery Calcification Score (CACS) and carotid ultrasonography in detecting subclinical atherosclerosis in rheumatoid arthritis (RA).

Methods A set of 104 consecutive RA patients without history of cardiovascular (CV) events were studied to determine CACS, carotid intima-media thickness (cIMT) and plaques. Systematic Coronary Risk Evaluation (SCORE) modified according to the EULAR recommendations (mSCORE) was also assessed.

Results The mean disease duration was 10.8 years, 72.1% had rheumatoid factor and/or anti-CCP positivity and 16.4% extra-articular manifestations. Nine were excluded because they had type 2 diabetes mellitus or chronic kidney disease. CV risk was categorised in the remaining 95 RA patients according to the mSCORE as follows: low (n=21), moderate (n=60) and high/very high risk (n=14). Most patients with low mSCORE (16/21; 76.2%) had normal CACS (zero), and none of them CACS>100. However, a high number of patients with carotid plaques was disclosed in the groups with CACS 0 (23/40; 57.5%) or CACS 1–100 (29/38; 76.3%). 72 (75.8%) of the 95 patients fulfilled definitions for high/very high CV as they had an mSCORE ≥5% or mSCORE <5% plus one of the following findings: severe carotid ultrasonography findings (cIMT>0.9 mm and/or plaques) or CACS>100. A CACS>100 showed sensitivity similar to mSCORE (23.6% vs 19.4%). In contrast, the presence of severe carotid ultrasonography findings allowed identifying most patients who met definitions for high/very high CV risk (70/72; sensitivity 97.2% (95% CI 90.3 to 99.7)).

Conclusions Carotid ultrasonography is more sensitive than CACS for the detection of subclinical atherosclerosis in RA.

  • Atherosclerosis
  • Rheumatoid Arthritis
  • Ultrasonography
  • Cardiovascular Disease

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