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The best cardiovascular risk calculator to predict carotid plaques in rheumatoid arthritis patients
Martin I Wah-Suarez1, Dionicio A Galarza-Delgado2, Jose R Azpiri-Lopez3
1Internal Medicine Department, University Hospital Dr. Jose Eleuterio Gonzalez UANL, Monterrey, Mexico.
Insights
Cardiovascular risk calculators show variable accuracy in rheumatoid arthritis (RA) patients. QRISK2 and ACC/AHA 2013 best correlated with carotid ultrasound findings, suggesting their utility in assessing subclinical atherosclerosis in RA.
Area of Science:
- Rheumatology
- Cardiology
- Medical Imaging
Background:
- Rheumatoid arthritis (RA) significantly elevates the risk of atherosclerotic cardiovascular disease (ASCVD), the primary cause of mortality in RA patients.
- Chronic inflammation and conventional risk factors exacerbate cardiovascular risk (CVR) in individuals with RA.
- Existing CVR calculators, validated in the general population, have uncertain precision for predicting cardiovascular outcomes in RA patients.
Purpose of the Study:
- To evaluate the correlation between various cardiovascular risk calculators and subclinical atherosclerosis detected by carotid ultrasound (US) in RA patients.
- To identify the most accurate risk calculator for predicting carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without overt cardiovascular manifestations.
Main Methods:
- A cross-sectional observational study involving 97 RA patients aged 40-75 years, meeting 2010 ACR/EULAR and/or 1987 ACR criteria.
- Clinical CVR assessment using seven distinct calculators.
- Carotid US to measure intima-media thickness (CIMT) and detect carotid plaque (CP).
Main Results:
- For CIMT, Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2 demonstrated the highest sensitivity.
- For CP detection, QRISK2, SCORE, and ACC/AHA 2013 exhibited the highest sensitivity.
- Significant variability in calculator performance was observed for detecting subclinical atherosclerosis in RA.
Conclusions:
- Comprehensive cardiovascular risk evaluation is essential for RA patients.
- Carotid US is a valuable tool for detecting subclinical atherosclerosis in RA, potentially warranting routine use.
- Lowering cutoff points on CVR scales may improve early detection of subclinical atherosclerosis and personalize therapy in intermediate-risk RA patients.
Abstract:
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors increase cardiovascular risk (CVR) in these patients. Several CVR calculators are used in general population and in RA patients to predict cardiovascular outcomes and tailor therapy but the precision of these calculators in RA patients has yet to be determined. The aim of this study is to determine which risk calculator correlates best with carotid ultrasound (US) findings, specifically carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without clinical manifestations. This was a cross-sectional observational study relating CVR scores in RA patients with the presence of carotid US findings. A total of 97 patients 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were selected. Clinical assessment of cardiovascular risk was performed using seven calculators and carotid US measurement of intima-media thickness and plaque. The tests with the highest sensitivity for CIMT were the Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2. In CP, the highest sensitivity was in QRISK2, SCORE, and ACC/AHA 2013. RA patients should be comprehensively evaluated to detect cardiovascular risk. Carotid US may be routinely recommended to detect subclinical atherosclerosis in RA patients. A lower cutoff point in CVR scales may be necessary to identify patients with a low and intermediate CVR to detect subclinical atherosclerosis earlier and personalize therapy.
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