Background Psoriatic arthritis (PsA) is associated with higher cardiovascular (CV) risk. The performances of established CV risk scores for general population in PsA patients have not been fully evaluated yet. Meanwhile, European League Against Rheumatism (EULAR) recommended to introduce a 1.5 multiplication factor to the CV risk scores for certain patients with rheumatoid arthritis. Whether the multiplication factor could improve the performances of the risk scores in PsA is unknown.
Objectives To evaluate the performances of different CV risk scores and their EULAR modified versions in detecting high CV risk in PsA patients defined as the presence of subclinical atherosclerosis (SCA) determined by carotid ultrasonography.
Methods Four different CV risk scores namely Framingham risk score (FRS), QRISK II, HeartScore and American College of Cardiology and American Heart Association (ACC/AHA) 10-year atherosclerotic cardiovascular disease (ASCVD) and their EULAR recommended modified versions were calculated. Sonographic evaluation measuring carotid intima-media thickness (IMT) and plaque was used to determine SCA. IMT>0.90 mm and/or the presence of plaque were classified as SCA+.
Results 162 patients [49.27±11.9 years, male: 95 (58.6%)] underwent carotid ultrasound were recruited. 142, 137, 128 and 118 patients were eligible to calculate FRS, QRISKII, HeartScore and ASCVD, respectively. 69 (34.3%) patients were considered to have high CV risk based on the presence of SCA. The SCA+ patients were significantly older (55±10 vs 45±12 years; p<0.001) and more diabetic [11 (15.9%) vs 12 (12.9%); p<0.001]. They also had higher systolic blood pressure (SBP: 138±25 vs 128±17 mmHg; p=0.003) and total cholesterol (TC: 5.3±0.9 vs 4.9±0.9 mmol/L, p=0.005). All CV risk scores were significantly higher in SCA+ patients (FRS: 17±14 vs 8±8%, p<0.001; QRISKII: 13±9 vs 7±7%, p=0.002; HeartScore: 3±3 vs 1±2%, p=0.001; ASCVD: 14±14 vs 8±8%, p=0.002). Areas under the receiver operating characteristic (ROC) curves discriminating SCA+ for FRS, QRISKII, HeartScore and ASCVD were 0.71 (0.63–0.80, p<0.001), 0.67 (0.58–0.76, p=0.001), 0.67 (0.58–0.77, p=0.001), and 0.67 (0.58–0.77, p=0.001), respectively. 42 (29.6%), 3 (2.2%), 6 (4.7%) and 35 (29.7%) patients were classified as having high CV risk scores according to FRS>10%, QRISK II>20%, HeartScore>5% and ASCVD>7.5%, respectively. By McNemar's test, all scores significantly underestimated the risk of SCA+ (all p<0.05, Figure 1a). By applying the EULAR multiplication factor, 55 (38.7%), 14 (10.2%), 7 (5.5%) and 53 (44.9%) patients were reclassified as having high CV risk, respectively. SCA+ risk was still significantly underestimated by the modified QRISKII and HeartScore, but not by the modified FRS (p=0.683) and ASCVD (p=0.885) (Figure 1b). EULAR modification increased the sensitivity of FRS and ASCVD in predicting SCA from 44% to 51%, and from 44% to 55%, respectively.
Conclusions All CV risk scores significantly underestimated the risk defined by carotid ultrasonography. EULAR recommended modification improved the sensitivity of FRS and ASCVD to a moderate level.
Disclosure of Interest None declared
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