Exploring cardiovascular disease risk evaluation in patients with inflammatory joint diseases

Area of Science:

• Cardiology
• Rheumatology
• Vascular Medicine

Background:

• Cardiovascular disease (CVD) risk calculators often miscalculate risk in patients with inflammatory joint disease (IJD).
• European guidelines identify carotid plaques (CP) as a significant CVD risk marker, similar to coronary artery disease.
• Patients with IJD exhibit a high prevalence of CP, indicating potential underestimation of their CVD risk.

Purpose of the Study:

• To determine if the presence of CP reclassifies IJD patients into a more accurate CVD risk category.
• To assess if identifying CP leads to appropriate recommendations for lipid-lowering treatment (LLT) in IJD patients.

Main Methods:

• Cardiovascular disease (CVD) risk was assessed in 335 IJD patients using SCORE and ACC/AHA risk calculators.
• The presence of carotid plaques (CP) was evaluated in these patients.
• Reclassification of CVD risk and LLT recommendations were analyzed based on CP status.

Main Results:

• A substantial proportion of IJD patients calculated to be at low-to-moderate CVD risk by SCORE (36.6%) and ACC/AHA (30.2%) had CP and warranted intensive LLT.
• The presence of CP led to reclassification for appropriate LLT in 54.9% (SCORE) and 58.1% (ACC/AHA) of high-risk IJD patients.
• CP identification significantly improved CVD risk reclassification, particularly in female IJD patients.

Conclusions:

• Asymptomatic atherosclerosis, indicated by CP, significantly impacts CVD risk stratification in IJD patients.
• Identifying CP is clinically important for reclassifying IJD patients to receive recommended CVD preventive treatment.
• This approach enhances the accuracy of CVD risk management in individuals with inflammatory joint diseases.