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Patients with a range of rheumatic diseases are at increased risk of cardiovascular disorders towards a re-evaluation of the European League against Rheumatism (EULAR)’s recommendations for cardiovascular risk management?
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  • Published on:
    Is there adequate evidence for the adoption of multipliers for cardiovascular risk estimation in rheumatic autoimmune diseases?
    • Maria G. Tektonidou, Professor of Rheumatology Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, Medi
    • Other Contributors:
      • Michael M. Ward, Rheumatologist

    We read with interest the article by Conrad et al. [1] that advocated modification of cardiovascular risk (CVR) scores to incorporate risk multipliers for each rheumatic and musculoskeletal disease (RMD). The proposed multipliers were based on hazard ratios for incident cardiovascular diseases in a nationwide study of electronic medical records in the UK [2]. This proposal contradicts recent recommendations in the 2022 EULAR recommendations for CVR management in patients with RMDs [3]. Based on a review of the evidence, including data of elevated CVR in other nationwide studies, and appraisal by experts, these recommendations did not support use of CVR multipliers in RMDs [3]. It is therefore important to examine several issues raised by this proposal.
    First, the objective of study from which the multipliers were derived [1] was not to assess the added predictive validity of CVR score modifiers, but rather to examine the incidence of cardiovascular disease in patients with autoimmune diseases. Confidence in the validity of the multipliers is not high, considering that data on blood pressure were missing in one-third of patients, while data on cholesterol and smoking were missing in two-thirds and almost one-half, respectively [2]. Also, whether these risk estimates apply in countries with baseline CVRs different from the UK is unclear [3].
    Second, the suggested multipliers were based on risk estimates of a wide range of cardiac or vascular diseases, including p...

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    Conflict of Interest:
    None declared.