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The PREVENT calculator underestimates cardiovascular disease risk in rheumatoid arthritis (RA) patients. Including hemoglobin A1c in the PREVENT tool significantly improves cardiovascular risk prediction for RA.

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Area of Science:

  • Rheumatology
  • Cardiovascular Medicine
  • Health Outcomes Research

Background:

  • Cardiovascular disease (CVD) risk assessment in rheumatoid arthritis (RA) is crucial due to increased CVD risk in this population.
  • Existing CVD risk calculators may not accurately reflect CVD risk in RA patients.

Purpose of the Study:

  • To evaluate the performance of the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator in patients with RA.
  • To compare the PREVENT calculator's performance with the Pooled Cohorts Equations (PCE) for atherosclerotic CVD (ASCVD) risk prediction in RA.

Main Methods:

  • A cohort of RA patients was matched with non-RA controls using national Veterans Health Administration (VHA), Medicare, and National Death Index data (2006-2020).
  • Ten-year CVD risk was calculated using the PREVENT calculator and compared between RA cases and controls for calibration and discrimination.
  • PREVENT performance was also compared against the PCE, including net reclassification index (NRI) calculations.

Main Results:

  • The PREVENT calculator underestimated overall CVD, ASCVD, and heart failure (HF) risk in RA patients compared to controls, with lower sensitivity for ASCVD and HF.
  • PREVENT demonstrated poorer performance for ASCVD prediction compared to the PCE, with a modest NRI.
  • Including hemoglobin A1c in the PREVENT calculator significantly improved its performance for overall CVD, ASCVD, and HF risk prediction in RA patients.

Conclusions:

  • The PREVENT calculator underestimates CVD risk in RA patients, highlighting the suboptimal performance of current risk calculators in this population.
  • Incorporating hemoglobin A1c into the PREVENT calculator is recommended to enhance CVD risk stratification in RA.
  • Further improvements in CVD risk assessment for RA patients are a high priority.