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The expanded cardiovascular risk prediction score as a cardiovascular mortality predictor in rheumatoid arthritis
Inmaculada Del Rincón1, Jose Félix Restrepo2, Agustin Escalante2
1Division of Rheumatoloy and Clinical Immunology, Department of Medicine, The University of Texas at San Antonio, TX, USA. delrincon@uthscsa.edu.
Insights
The expanded cardiovascular risk prediction score for rheumatoid arthritis (ERS-RA) better predicts cardiovascular death in RA patients than the Framingham score. Carotid intima-media thickness also showed improved prediction over the Framingham score.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) mortality.
- Accurate prediction of CV risk in RA patients is crucial for timely intervention.
- Existing CV risk scores may not fully capture the excess risk in RA.
Purpose of the Study:
- To evaluate the performance of the expanded cardiovascular risk prediction score for rheumatoid arthritis (ERS-RA) in predicting CV mortality.
- To compare the ERS-RA with the Framingham CV risk score and carotid intima-media thickness (IMT) for CV mortality prediction in RA patients.
Main Methods:
- A cohort of 1194 RA patients with available ultrasound carotid IMT measurements and clinical data was studied.
- CV mortality was identified using death certificates and ICDM-9 codes.
- Performance was assessed by comparing areas under receiver operator characteristic curves (ROC AUC) and reclassification tables.
Main Results:
- Over 10,063 person-years, 139 CV deaths occurred (1.4 per 100 person-years).
- The ERS-RA demonstrated the highest predictive performance with an ROC AUC of 0.84.
- The ERS-RA correctly reclassified 6% of patients compared to the Framingham scale, while carotid IMT reclassified 5%.
Conclusions:
- The ERS-RA is a superior predictor of CV mortality in RA patients compared to the Framingham score.
- Carotid IMT also offers improved CV risk prediction in this population.
- These findings support the use of ERS-RA for enhanced CV risk assessment in RA.
Objectives:
We aimed to examine the performance of the expanded cardiovascular (CV) risk prediction score for rheumatoid arthritis (ERS-RA), the Framingham CV risk score and the carotid intima-media thickness (IMT) as predictors of CV mortality in patients with rheumatoid arthritis (RA).
Methods:
We studied 1194 patients with RA who had an ultrasound measurement of the carotid IMT and who had clinical information to calculate the ERS-RA and the Framingham score. Deaths were confirmed by death certificate and attributed to a CV cause if the immediate or underlying cause of death was due to ICDM-9 codes 390-459. We compared areas under receiver operator characteristic curves (ROC AUC) and examined reclassification tables for the performance of each scale to correctly predict CV deaths.
Results:
Patients were observed for 10,063 person-years, during which 271 patients died (22.6%), for an overall mortality rate of 2.7 deaths per 100 person-years (95% CI 2.4, 3.0). A CV cause of death was identified in 139 patients (11.6%), for a CV mortality rate of 1.4 per 100 person-years (1.2, 1.6). ROC AUCs were 0.72 (95% CI 0.68, 0.76) for the Framingham scale, 0.76 (95% CI 0.72, 0.81) for the carotid IMT and 0.84 (95% CI 0.81, 0.88) for the ERS-RA. Compared to the Framingham scale the ERS-RA correctly reclassified 6% of patients (p=0.02), while the carotid IMT correctly reclassified 5% (p=0.003).
Conclusions:
The ERS-RA was superior to the Framingham scale in the prediction of CV mortality in patients with RA.
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