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SCORE and REGICOR function charts underestimate the cardiovascular risk in Spanish patients with rheumatoid arthritis
Insights
Cardiovascular risk scores Systematic COronary Risk Evaluation (SCORE) and Framingham-REgistre GIroní del COR (REGICOR) were not effective for Spanish rheumatoid arthritis (RA) patients. Neither score accurately identified high cardiovascular risk in this population.
Area of Science:
- Rheumatology
- Cardiology
- Medical Risk Assessment
Background:
- Cardiovascular disease is a significant concern in rheumatoid arthritis (RA) patients.
- Accurate cardiovascular (CV) risk assessment is crucial for managing RA patients.
- Existing CV risk charts may not be suitable for all patient populations.
Purpose of the Study:
- To evaluate the effectiveness of two CV risk assessment tools, Systematic COronary Risk Evaluation (SCORE) and Framingham-REgistre GIroní del COR (REGICOR), in Spanish patients with RA.
- To determine which, if either, of these risk scores is more appropriate for use in this specific patient group.
Main Methods:
- A cohort of 370 RA patients without prior CV events was assessed.
- Cardiovascular risk was calculated using modified SCORE (mSCORE) and modified REGICOR (mREGICOR) with European League Against Rheumatism (EULAR) recommendations.
- Severe subclinical atherosclerosis and high CV risk were identified using carotid ultrasonography (US) (US+), serving as the gold standard.
Main Results:
- Over half (53%) of RA patients exhibited signs of severe subclinical atherosclerosis (US+).
- Both mSCORE and mREGICOR demonstrated limited ability to identify US+ patients, failing to detect 88% and 91% respectively.
- A significant proportion of patients with low calculated risk (mSCORE ≥1% or mREGICOR >1%) were found to have US+.
Conclusions:
- Neither the mSCORE nor mREGICOR risk assessment tools are reliable for estimating cardiovascular risk in Spanish RA patients.
- Further research is needed to develop or validate appropriate CV risk assessment tools for RA populations.
Introduction:
Our objective was to determine which one of the two function charts available in Spain to calculate cardiovascular (CV) risk, Systematic COronary Risk Evaluation (SCORE) or Framingham-REgistre GIroní del COR (REGICOR), should be used in patients with rheumatoid arthritis (RA).
Methods:
A series of RA patients seen over a one-year period without history of CV events were assessed. SCORE, REGICOR, modified (m)SCORE and mREGICOR according to the European League Against Rheumatism (EULAR) recommendations were applied. Carotid ultrasonography (US) was performed. Carotid intima-media thickness (cIMT) > 0.90 mm and/or carotid plaques were used as the gold standard test for severe subclinical atherosclerosis and high CV risk (US+). The area under the receiver operating curves (AUC) for the predicted risk for mSCORE and mREGICOR were calculated according to the presence of severe carotid US findings (US+).
Results:
We included 370 patients (80% women; mean age 58.9 ± 13.7 years); 36% had disease duration of 10 years or more; rheumatoid factor (RF) and/or anticyclic citrullinated peptide (anti-CCP) were positive in 68%; and 17% had extra-articular manifestations. The EULAR multiplier factor was used in 122 (33%) of the patients. The mSCORE was 2.16 ± 2.49% and the mREGICOR 4.36 ± 3.46%. Regarding US results, 196 (53%) patients were US+. The AUC mSCORE was 0.798 (CI 95%: 0.752 to 0.844) and AUC mREGICOR 0.741 (95% CI; 0.691 to 0.792). However, mSCORE and mREGICOR failed to identify 88% and 91% of US+ patients. More than 50% of patients with mSCORE ≥1% or mREGICOR >1% were US+.
Conclusions:
Neither of these two function charts was useful in estimating CV risk in Spanish RA patients.
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