Background/Purpose:

Rheumatoid Arthritis (RA) is associated with a greater cardiovascular mortality than the general population of the same age and gender. Cardiovascular events prediction scales, due to its significant dependence on age, underestimate absolute cardiovascular risk (CVR) in young people. Two methods exist to address this problem: a) Cardiovascular Relative Risk, which estimates the increased risk when compared to people of the same age without CVRF. B) Vascular age, defined as the lower age with the same absolute CVR but with no CVRF. OBJECTIVE: To evaluate the utility of the relative cardiovascular risk score scales and the vascular age predictors in patients with RA, younger than 50 years of age.

Methods:  Transversal prospective study developed at the Rheumatology Services in two Spanish academic hospitals. Only patients under 50 years of age who fulfilled the EULAR/ACR 2010 criteria for RA were included. They were selected consecutively when they came on regular follow-up. We registered to calculate SCORE, REGICOR, Relative Cardiovascular Risk and Vascular Age (age, gender, tobacco habits, systolic blood pressure, total serum cholesterol concentration and HDL and diabetes Mellitus). According to the EULAR 2011 recommendations, a multiplying factor of 1,5 was applied to SCORE, REGICOR and Relative Cardiovascular Risk in patients who fitted in at least two of the following criteria: a) Duration of RA > 10 years, b) positive RF or CCP , c) Presence of extra-articular manifestations.

Results: 140 patients with RA under 50 years of age were included [120 (86%) women] with an mean age of 40 ± 7 years. 64% of patients had RF+ and 56% CCP+. Regarding to EULAR multiplying factors, 30% had RA duration > 10 years, 71% had CCP or RF+, 11% had extra-articular manifestations, and 26% had 2 or more factors. None of the patients had has a previous history of cardiovascular events. The modified (after the application of the multiplying fact) mean SCORE was 1,03 ± 0,52 and modified REGICOR 1,81 ± 1,37. Mean Cardiovascular relative risk was 2,05 ± 1,33 between 2x and 10x. 54% of the patients had a relative cardiovascular risk superior to 1, and 47% had cardiovascular relative risk between 2 and 3 times higher. Mean vascular Age’s was of 44 ± 10 years, 4 years more than biological age. 41% of patients, vascular age was greater than biological age, from 3 to 20 years older. Relative Cardiovascular risk identifies more patients with CVR than Vascular Age. Patients with increased relative cardiovascular risk were older (41 ± 6 vs 38 ± 9 years; p < 0,01) and had been diagnosed with RA for over10 years (40% vs 7%, p < 0,001).

Conclusion:  In young patients with Rheumatoid Arthritis, the estimates of Relative Cardiovascular Risk and the assessment of vascular age allow us to identify patients with an increased cardiovascular risk, who may be overlooked by SCORE event prediction charts.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-relative-cardiovascular-risk-score-scales-and-vascular-age-predictors-in-patients-with-reumathoid-arthritis-under-50-years-of-age/