Performances of five risk algorithms in predicting cardiovascular events in patients with Psoriatic Arthritis: An
Luca Navarini1, Domenico Paolo Emanuele Margiotta1, Francesco Caso2
1Unit of Allergology, Cinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy.
Insights
Cardiovascular risk algorithms adapted for psoriatic arthritis (PsA) did not improve risk prediction. Most cardiovascular events occurred in patients categorized as low or low-intermediate risk, indicating current models are insufficient for this population.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Psoriatic arthritis (PsA) is associated with increased cardiovascular (CV) risk.
- European League Against Rheumatism (EULAR) suggests multiplying CV risk algorithms by 1.5 for inflammatory arthritis.
- The effectiveness of this adaptation in PsA requires evaluation.
Purpose of the Study:
- To assess the performance of five CV risk algorithms (SCORE, CUORE, Framingham Risk Score, QRISK2, Reynold's Risk Score) in PsA patients.
- To evaluate the impact of EULAR recommendations on the accuracy of these algorithms.
- To determine the distribution of CV events across different risk categories in PsA.
Main Methods:
- Utilized prospectively collected data from two Italian cohorts.
- Evaluated discriminatory ability using Area Under the Receiver Operating Characteristic Curves (AUC).
- Assessed calibration with Hosmer-Lemeshow (HL) tests and calculated sensitivity and specificity.
Main Results:
- QRISK2 and CUORE showed the highest AUCs, but HL tests indicated poor model fit for SCORE, CUORE, and RRS.
- Adapting algorithms per EULAR recommendations did not enhance discriminative ability or calibration.
- A significant proportion of CV events (up to 80% in low risk, 93% in low-intermediate risk) occurred in patients underestimated by the models.
Conclusions:
- EULAR-adapted CV risk algorithms do not improve risk prediction in PsA patients.
- Current risk assessment models inadequately identify high-risk individuals with PsA.
- Further research is needed to develop more accurate CV risk prediction tools for PsA.
Introduction:
In patients with psoriatic arthritis (PsA) an increased cardiovascular (CV) risk has been observed. Recently, a EULAR taskforce suggested to use a multiplication by the factor of 1.5 of CV risk algorithms in patients with inflammatory arthritis. This study aims to evaluate the performance of five original and adapted according to EULAR recommendations CV risk algorithms in PsA: SCORE, CUORE, Framingham Risk Score (FRS), QRISK2, and Reynold's Risk Score (RRS).
Methods:
Prospectively collected data from two Italian cohorts were used. Discriminatory ability for CV risk prediction was evaluated by the area under the ROC curves. Calibration between predicted and observed events was assessed by Hosmer-Lemeshow (HL) tests. Sensibility and specificity were calculated for low-to-intermediate and intermediate-to-high risk cut-offs.
Results:
One hundred fifty-five patients were enrolled with an observation of 1550 patient/years. Area under the ROC were 0.7679 (95% CI 0.64768 to 0.88812), 0.864 (95% CI 0.79675 to 0.93278), 0.7575 (95% CI 0.65784 to 0.85708), 0.8660 (95% CI 0.79428 to 0.93772), and 0.7183 (95% CI 0.57795 to 0.85862) for SCORE, CUORE, FRS, QRSIK2, and RRS, respectively. HL tests demonstrated poor model fit (p<0.05) for SCORE, CUORE, and RRS. Discriminative ability and calibration were not improved by adaption of the algorithms according to EULAR recommendations. Up to 80% of CV events occurred in patients at "low risk" and up to 93% of CV events in patients at "low-intermediate risk".
Conclusions:
Adaption of the CV risk algorithms according to EULAR indications did not provide improvement in discriminative ability and calibration in patients with PsA.
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