Performance of the new PREVENT score for indicating subclinical atherosclerosis in rheumatoid arthritis

Area of Science:

• Cardiology
• Rheumatology
• Medical Imaging

Background:

• Rheumatoid arthritis (RA) patients face elevated risk of atherosclerotic cardiovascular disease (ASCVD).
• Traditional 10-year cardiovascular disease (CVD) risk calculators, like the 2013 Pooled Cohort Equations (PCE), often underperform in RA populations.
• Subclinical atherosclerosis detection is crucial for accurate CVD risk assessment in RA.

Purpose of the Study:

• To compare the performance of the PCE against the updated PREVENT algorithm in identifying subclinical coronary and carotid atherosclerosis in RA patients.
• To evaluate the utility of different PREVENT scores (Total CVD, ASCVD, Total CVD + uACR) in this context.

Main Methods:

• Patients with RA and no known CVD underwent chest CT for coronary artery calcium (CAC) scoring and carotid artery ultrasound for plaque detection.
• PCE and three 10-year PREVENT scores were calculated for each patient.
• The predictive performance of PCE and PREVENT scores for CAC and carotid plaque was compared using area under the receiver operating characteristic curves (AUROC).

Main Results:

• Both PCE and PREVENT scores were significantly associated with the presence of CAC and carotid plaque.
• The PCE demonstrated a higher AUROC (0.775) than the PREVENT ASCVD score (0.723) in predicting CAC >0 (P=0.034).
• No significant difference in AUROC was observed between PCE and PREVENT scores for predicting carotid plaque.

Conclusions:

• The updated PREVENT algorithm does not offer improved prediction of subclinical coronary or carotid atherosclerosis in RA patients compared to the PCE.
• Given the known underperformance of PCE in RA, the PREVENT algorithm is unlikely to adequately predict future CVD events in this population.
• Further research is needed to develop accurate CVD risk prediction tools for RA patients.