Background/Purpose: Increased cardiovascular (CV) risk have been described in patients with rheumatic diseases including spondyloarthritis (SpA). Besides traditional CV risk factors, disease specific factors have been suggested as possible etiologic factors for atherosclerosis. Increased carotid Intima-media thickness (IMT) has been found to be increased in rheumatic diseases. In RA and other inflammatory arthritis, EULAR recommends annual CV risk assessment according to national guidelines, but there is not a calibrated SCORE chart for SpA patients. 

Objectives: To asses CV risk in SpA patients using the SCORE chart calibrated for Spain (SCOREm) and to determine the percentage of patients  reclassified according to the presence of plaques by the use of common carotid artery (CCA) ultrasonography (US). To analyse the factors that predict a higher global CV risk. 

Methods: All patients with SpA, fulfilling the “Assessment of SpondyloArthritis international Society” (ASAS) classification criteria, without previous ischemic events were prospectively included in a database, containing demographic and clinical information. For the study, 90 living spanish patients were selected. Classic CV risk factors, acute phase reactants (APR), disease activity indexes and lipid profile were obtained. CV risk was calculated using the SCOREm and the presence of plaques – measure of the CCA IMT was evaluated by B-doppler US.  Chi-square or McNemar`s tests were used to assess differences between qualitative variables, and ANOVA with Bonferroni adjustment for comparing means. Factors predicting higher global CV risk were evaluated by multivariate lineal regression analysis.

Results: Most patients (54%) were men, 77% were HLA-B27 positive. Mean age was 46,32±14,4 years and mean disease duration was 8,8±6,8 years. Mean SCOREm was 1,3±2,7. Low CV risk was found in 64(71%) patients, intermediate, high and very high risk in 23(25,7%), 2 (2,2%) and 1(1,1%) patients respectively. After CCA US was performed, plaques were found in 10/90(11,1 %) patients. Of these, reclassification to high risk was done in 3 and 5 patients with low and intermediate risk respectively (p<0,001). Mean IMT was 0,61±0,11 mm. Higher global CV risk was predicted by hypertension (β 3,66; p=0,00), dyslipidemia (β -1,77; p=0,016), time of disease (β 0,075; p=0,040) and HLA-B7 positivity (β -1,82; p=0,002).

Conclusion: In our study most SpA patients have low and intermediate CV risk using the SCOREm chart, but after performing CCA US 8(8,9%) patients were  reclassified into high risk by the presence of plaques. Besides  classic CV risk factors, some disease characteristics might contribute to the expression of higher global CV risk in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-assessment-in-spondyloarthritis-using-the-score-chart-and-reclassification-by-presence-of-plaques-on-ultrasonography/