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Abstract Number: 2136

Cardiovascular Risk Evaluation in Systemic Lupus Erythematosus and Rheumatoid Arthritis: Preliminary Results from the “Cardiovascular Obesity and Rheumatic DISease (CORDIS)” Study Group of the Italian Society of Rheumatology

Fabio Cacciapaglia1, Gian Luca Erre 2, Garifallia Sakellariou 3, Ombretta Viapiana 4, Matteo Piga 5, Elena Bartoloni 6, Andreina Manfredi 7, Sergio Colella 1, Floriana Castagna 2, Giacomo Cafaro 8, Martina Dessì 5, Marco Fornaro 1, Alessandro Giollo 9, Silvia Grignaschi 10, Caterina Vacchi 11, Francesca Romana Spinelli 12, Fabiola Atzeni 13 and Elisa Gremese 14, 1Rheumatology Unit – Department of Emergency and Organs Transplantation, University and AOU Policlinico of Bari, Italy, Bari, Italy, 2Specialità Mediche, Azienda Ospedaliero Universitaria di Sassari, Italy., Sassari, Italy, 3Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy, 4University of Verona, Verona, Italy, 5Rheumatology Unit, Department of Medical Sciences, University and AOU Policlinico of Cagliari, Italy., Cagliari, Italy, 6Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy, Perugia, Italy, 7Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy, 8Rheumatology Unit, Department of Medicine, University of Perugia, Italy., Perugia, Italy, 9Rheumatology Unit, Department of Medicine, University of Verona, Italy., Verona, Italy, 10Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Pavia, Italy, 11Rheumatology Unit, Department of Medical and Surgical Science, University and AOU Policlinico of Modena, Italy., Modena, 12Rheumatology, Department of Internal Medicine and Medical Speciality, Sapienza University of Rome, Italy., Rome, Italy, 13Rheumatology Unit, University of Messina, Messina, Italy., Messina, Italy, 14Fondazione Policlinico Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Cardiovascular disease, morbidity and mortality, risk assessment, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA)

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Session Information

Date: Tuesday, November 12, 2019

Session Title: Miscellanous Rheumatic & Inflammatory Disease Poster III: Autoimmune Conditions and Therapies

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients present high cardiovascular (CV) morbidity and mortality. International guidelines suggest estimating CV-risk in these patients, but no indications about the strategy to use are specified. This multicentre cross-sectional study aimed to investigate the performance in real-life setting of three different 10-years CV-risk estimating algorithms in SLE and RA.

Methods: Data of 989 patients with SLE (140 patients; female 85.7%; age 40±16 years; disease duration 155±106 months) and RA (849 patients; female 79.3%; age 61±12 years; disease duration 133±110 months), according to specific classification criteria, were collected since January 2019 in 10 rheumatologic University Hospitals. Clinical and laboratory parameters were registered, and individual CV-risk was calculated using the “Progetto Cuore”, QRisk3 and Reynolds risk scores (RRS), as stated by suitable algorithms. Statistical analysis was performed with appropriate tests using the Statistical System Prism (Graphpad Instat 6.0 – San Diego CA-USA).

Results: Fifty-six (6.6%) RA and 14 (10%) SLE patients had experienced a previous CV event (mainly myocardial- infarction). Among traditional CV-risks RA patients were significantly older (p< 0.0001), hyperlipidaemia was more prevalent in RA then SLE (57.8% vs 37.1%; p< 0.001), and similar prevalence of hypertension and diabetes was recorded. Mean BMI was not significantly different between groups, nevertheless a BMI >25 Kg/m2 was more prevalent in RA than SLE (47.8% vs 14.2% – p< 0.0001). RA patients were more frequently smokers (23.7% vs 13.6% – p=0.007). C-reactive protein was significantly higher in RA compared to SLE patients (6.8±1.1 vs 3.8±0.4 mg/l – p=0.01). Median (IQR) CDAI and SLEDAI were 7 (3-12) and 2 (0-2) in RA and SLE, respectively, and low-disease or remission according to CDAI (< 10) and SLEDAI (< 4) was similar. Sixty-eight percent of SLE patients were on a mean prednisone-dose of 5.9±2.6 mg/day whereas 41% of RA patients took 5.0±2.8 mg/day of prednisone (p< 0.01). All SLE patients were on hydroxychloroquine, 78 (55.7%) were co-treated with an immunosuppressant agent and 9 (6.4%) with belimumab or rituximab. Seventy percent of RA patients were on csDMARDs, mainly methotrexate, and 49.5% used also a biologic agent. CV-risk with QRisk3 results 2 to 3-fold higher compared to RRS and “Progetto Cuore” score in both patient groups. Moreover, QRisk3 and RRS resulted significantly higher in RA compared to SLE (Figure1A). Interestingly, only in RA a positive correlation between CDAI and QRisk3 (r=0.1; p=0.03) was detected (Figure1B).

Conclusion: This multicentre study showed a different performance in SLE and RA patients of the commonly used algorithms to estimate CV-risk in clinical practice. With a good disease activity control, traditional CV-risk factors may differently impact on predictable CV-risk using the “Progetto Cuore” scores, QRisk3 or the RRS. These findings should be considered when CV-risk is estimated routinely in such patients.

A. Estimated % 10-years cardiovascular risk in SLE and RA patients according to “Progetto Cuore”, QRisk3 and Reynolds risk scores.
B. Correlation between CDAI and QRisk3 score in RA patients.


Disclosure: F. Cacciapaglia, None; G. Erre, None; G. Sakellariou, None; O. Viapiana, Abiogen; M. Piga, None; E. Bartoloni, None; A. Manfredi, None; S. Colella, None; F. Castagna, None; G. Cafaro, None; M. Dessì, None; M. Fornaro, None; A. Giollo, None; S. Grignaschi, None; C. Vacchi, None; F. Spinelli, None; F. Atzeni, None; E. Gremese, AbbVie, 5, 8, BMS, 5, 8, Celgene, 5, 8, Janssen, 5, 8, Lilly, 5, 8, MSD, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8, Sanofi, 5, 8, UCB, 5, 8.

To cite this abstract in AMA style:

Cacciapaglia F, Erre G, Sakellariou G, Viapiana O, Piga M, Bartoloni E, Manfredi A, Colella S, Castagna F, Cafaro G, Dessì M, Fornaro M, Giollo A, Grignaschi S, Vacchi C, Spinelli F, Atzeni F, Gremese E. Cardiovascular Risk Evaluation in Systemic Lupus Erythematosus and Rheumatoid Arthritis: Preliminary Results from the “Cardiovascular Obesity and Rheumatic DISease (CORDIS)” Study Group of the Italian Society of Rheumatology [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/cardiovascular-risk-evaluation-in-systemic-lupus-erythematosus-and-rheumatoid-arthritis-preliminary-results-from-the-cardiovascular-obesity-and-rheumatic-disease-cordis-study-grou/. Accessed January 17, 2021.
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