Diagnosis of Carotid Plaque By 4 Cardiovascular Risk Scores in Rheumatoid Arthritis

Raymundo Vera-Pineda¹, Alberto Cardenas-de La Garza², Dionicio A. Galarza-Delgado², Jose Ramon Azpiri-Lopez³, Iris J. Colunga-Pedraza², Judith Garcia-Colunga⁴, Guillermo Elizondo⁴, Mario Alberto Garza-Elizondo², Jesus Zacarias Villarreal-Pérez⁵ and Griselda Serna-Peña⁶, ¹Cardiology., Hospital Universitario, UANL., Monterrey, Mexico, ²Rheumatology, Hospital Universitario, UANL., Monterrey, Mexico, ³Cardiology, Hospital Universitario, UANL., Monterrey, Mexico, ⁴Radiology, Hospital Universitario, UANL., Monterrey, Mexico, ⁵Endocrinology, Hospital Universitario, UANL., Monterrey, Mexico, ⁶Internal Medicine, Hospital Universitario, UANL., Monterrey, Mexico

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Cardiovascular disease, rheumatoid arthritis (RA) and risk assessment

Session Information

Date: Monday, November 9, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster II

Session Type: ACR Poster Session B

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

Background/Purpose:

The leading cause of death in RA is atherosclerotic cardiovascular disease (ASCVD). Traditional risk factors do not explain the increased cardiovascular risk (CVR), which appears to be linked to inflammatory pathways. Several CVR calculators have been developed for the general population. The most widely used are the Framingham Lipids (FRS Lipids), Framingham BMI (FRS BMI), ACC/AHA 2013 cardiovascular risk calculator (OMNIBUS) and QRISK2 calculator. FRS has shown to underestimate and QRISK2 to overestimate CVR. Carotid artery evaluation by ultrasound is a useful tool for the detection of subclinical atherosclerosis. Carotid plaque (CP) presence significantly increases the risk of ASCVD, mainly stroke and myocardial infarction.

Methods:

A cross-sectional study was designed. Patients with RA were prospectively and consecutively recruited. All fulfilled the ACR/EULAR 2010 classification criteria. Presence of prior ASCVD, overlap syndromes and patients younger than 40 or older than 75 were excluded. A certified radiologist performed the carotid ultrasound. CP was defined as focal thickening of at least 50% greater than that of the surrounding wall or carotid intima media-thickness ≥ 1.2 mm. CVR by 4 different algorithms was calculated online in the official sites. Diagnostic performance was calculated using receiver operating characteristics (ROC curves). Area under the curve (AUC) values greater than .5 with p<0.05 were considered statistically significant.

Results:

A total of 97 patients were included. The demographical characteristics are shown in table 1. CP was present in 40 patients (41.2%). Patients with CP were categorized as low-risk by FRS Lipids in 60%, QRISK2 IN 50%, OMNIBUS in 50% and FRS BMI in 42.5% of cases. ROC curves showed poor AUC values, with no significant difference between them (p>0.05). The best cut-off point for OMNIBUS was 2.05%, 5% for FRS Lipids, 4.95% for FRS BMI and a 2.9% for QRISK2 (Table2).

Conclusion:

CVR calculators are poor diagnostic tools for CP detection. There is no difference between the ROC curves for the different CVR algorithms in RA. Most of the patients with CP are stratified as low-risk patients by current algorithms.

Table 2. ROC curves and Diagnostic performances
CVR Scale	AUC ± Standard error	P value	Suggested Cut-off value	Sensitivity	Specificity	Negative predictive value
OMNIBUS	.690 ± .053	.001	2.05%	.900	.473	.871
FRS Lipids	.681 ± .054	.002	5%	.900	.386	.846
FRS BMI	.671 ± .055	.004	4.95%	.900	.350	.833
QRISK2	.677 ± .054	.003	2.9%	.900	.350	.833

Table 1. Demographical characteristics
Feminine, n (%)	88 (90.7)
Age (yo), mean ± SD	56.3 ± 9.6
Duration of disease (yo), mean ± SD	12.78 ± 8.2
Currently smoking, n (%)	25 (25.8)
Family history of MI, n (%)	9 (9.3)
Dyslipidemia, n (%)	26(26.8)
Type 2 diabetes mellitus, n (%)	14 (14.4)
On antihypertensive drugs, n (%)	36 (37.1)
Total cholesterol (mg/dl), mean ± SD	187.59 ± 33.6
HDL cholesterol (mg/dl), mean ± SD	55.75 ± 15.6
LDL cholesterol (mg/dl), mean ± SD	101.2 ± 29.4
ESR, mean ± SD	26.49 ± 13.9
BMI, mean ± SD	28.12 ± 4.96
Systolic BP (mmHg), mean ± SD	124.7 ± 14.3
OMNIBUS, median (p25-p75)	3.8 (1.6-7.05)
FRS Lipids, median (p25-p75)	7.1 (4.6-10.6)
FRS BMI, median (p25-p75)	9.4 (4.95-14.7)
QRISK2, median (p25-p75)	7 (2.9-13.3)
CIMT, median (p25-p75)	.08 (.07-.09)

Disclosure: R. Vera-Pineda, None; A. Cardenas-de La Garza, None; D. A. Galarza-Delgado, None; J. R. Azpiri-Lopez, None; I. J. Colunga-Pedraza, None; J. Garcia-Colunga, None; G. Elizondo, None; M. A. Garza-Elizondo, None; J. Z. Villarreal-Pérez, None; G. Serna-Peña, None.

To cite this abstract in AMA style:

Vera-Pineda R, Cardenas-de La Garza A, Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Garcia-Colunga J, Elizondo G, Garza-Elizondo MA, Villarreal-Pérez JZ, Serna-Peña G. Diagnosis of Carotid Plaque By 4 Cardiovascular Risk Scores in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/diagnosis-of-carotid-plaque-by-4-cardiovascular-risk-scores-in-rheumatoid-arthritis/. Accessed .

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