Background/Purpose: Cardiovascular disease is the major cause of death in rheumatoid arthritis (RA) patients. Cardiovascular risk algorithms are employed to assess the likelihood of experiencing a major cardiovascular event within 10 years based on the presence of conventional cardiovascular risk factors, however, no algorithm existed for the Hispanic population until the World Health Organization (WHO) published the cardiovascular disease risk charts for 21 regions, including Mexico. This study aimed to compare the effectiveness of the 2019 WHO algorithm and the 2013 ACC/AHA algorithm in detecting the presence of carotid plaque (CP) in patients with RA.

Methods: This was a cross-sectional study. We recruited a total of 164 patients with RA diagnosis, according to the 2010 ACR/EULAR classification criteria, aged 40-75 years. Patients with a previous cardiovascular event were excluded. Cardiovascular risk was evaluated with the 2019 WHO algorithm for the Mexican population and the 2013 ACC/AHA cardiovascular algorithm. The results were multiplicated by 1.5, according to current guidelines. A carotid ultrasound was performed to all study subjects by a certified radiologist blinded to clinical information. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations were performed with the Spearman-rho coefficient (rho). A ROC-curve analysis was performed for both algorithms. The areas under the curve (AUC) of the algorithms were compared using the method of DeLong. A p-value < 0.05 was considered statistically significant.

Results: The presence of CP was detected in 59 (36.0%) patients. Demographic characteristics are shown in Table 1. There was a large positive correlation between the WHO and the ACC/AHA algorithms (rho = 0.880, p = < 0.001). Both algorithms showed significant discrimination for the presence of CP in RA patients, the WHO algorithm had an AUC 0.729 (95% CI 0.649-0.809, p = < 0.001) and the ACC/AHA algorithm had an AUC 0.687 (95% CI 0.604-0.770, p = < 0.001). However, there was a difference when comparing the AUC for both algorithms, with the WHO algorithm demonstrating a higher AUC value (p = 0.042) (Figure 1).

Conclusion: Our findings indicate that both algorithms exhibited significant discrimination for the presence of CP. However, in the Hispanic RA population, the 2019 WHO algorithm displayed superior capacity for detecting CP compared to the 2013 ACC/AHA algorithm. The WHO algorithm is more suitable for the Hispanic RA population due to its tailored design specifically for their demographic characteristics. Consequently, it outperforms the ACC/AHA algorithm in accurately detecting and assessing cardiovascular risk factors in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparing-the-world-health-organization-and-the-american-college-of-cardiology-american-heart-association-algorithms-for-detection-of-carotid-plaque/