Cardiovascular risk assessment in rheumatoid arthritis - controversies and the new approach

Area of Science:

• Rheumatology
• Cardiology
• Epidemiology

Background:

• Cardiovascular (CV) risk assessment in inflammatory connective tissue diseases, particularly rheumatoid arthritis (RA), faces significant controversy.
• Existing guidelines show limited consensus on employing formal CV risk calculators for RA patients.
• Key recommendations include the EULAR guidelines favoring SCORE and British Society for Rheumatology guidelines recommending QRISK-2.

Purpose of the Study:

• To review and compare current methods for CV risk assessment in rheumatoid arthritis (RA).
• To analyze the utility of general population risk calculators adapted for RA versus RA-specific calculators.
• To discuss the effectiveness of various risk prediction tools, including the Pooled Cohort Equation, in both general and RA populations.

Main Methods:

• Comparative analysis of CV risk assessment strategies outlined in current rheumatoid arthritis (RA) guidelines.
• Review of recent reports from American and British health authorities regarding CV risk prediction.
• Discussion of specific risk calculators: SCORE, QRISK-2, Expanded Cardiovascular Risk Prediction Score for RA, and the Pooled Cohort Equation.

Main Results:

• Few rheumatoid arthritis (RA) guidelines advocate for formal CV risk calculators.
• Two primary approaches emerge: adapting general population calculators (e.g., QRISK-2) for RA, or developing RA-specific tools (e.g., Expanded Cardiovascular Risk Prediction Score for RA).
• The efficiency of newer calculators like the Pooled Cohort Equation in RA populations requires further evaluation.

Conclusions:

• There is a lack of standardized CV risk assessment methodology for rheumatoid arthritis (RA) patients.
• The choice between general and RA-specific risk calculators remains a key point of discussion.
• Further research is needed to validate the performance of various risk prediction models in the RA population.