Background/Purpose:  chronic inflammatory diseases are at a substantially increased risk of cardiovascular disease. Framingham risk score (FRS) underestimates cardiovascular risk in many inflammatory diseases. Our objective was to assess the predictive ability of Framingham score model for the 10-year risk of fatal and non-fatal CV diseases in patients with Polymyalgia Rheumatica (PMR).

Methods: we retrospectively reviewed electronic medical records of patients registered in our hospital after year 2000 with the diagnosis of PMR. Patients fulfilling ACR PMR 2012 criteria or with a clinical diagnose made by a rheumatologist were included. Patients with history of cardiovascular event before diagnosis, age greater of 80 years at diagnosis or with less than 10 years of follow up after diagnosis, were excluded. Framingham score was calculated at diagnosis, and based on the FRS, patients were classified into low, intermediate and high-risk categories. Cardiovascular (CV) events such as stroke, transient ischemic attack, coronary arterial disease and peripheral vasculopathy were identified during follow up. Discriminatory ability for CV risk prediction was estimated by the area under the receiver operating characteristic (ROC) curve. Global cardiovascular risk was calculated at 10 years after PMR diagnosis and compared with FRS estimated at diagnosis.

Results: A total of 97 patients were included. Patients characteristics are described in table. Among the 97 patients followed up for a total of 981.5 person-years, 18 CV events occurred with an incidence rate of 1.83 per 100 patient-years (95% CI: 1.1-2.9). There were no differences in clinical characteristics among patients with and without CV events (table). The area under the ROC curve for FRS was 0.61 (95% CI: 0.47- 0.74), indicating low discrimination between patients with and without a CV event. According to FRS 17 (17.5 %), 46 (47.4%) and 34 (35%) patients were classified into low, intermediate and high risk categories respectively. Across the three predicted CV risk groups the observed/predicted CV events (%) were:0.059/0.065; 0.2/0.13; and 0.24/0.26 for low, intermediate and high risk categories respectively. When observed vs predicted CV events in quintiles of CV risk were compared, the following values were obtained: 0.1 vs 0.072; 0.16 vs 0.12; 0.20 vs 0.16; 0.31 vs 0.34.

Conclusion: FRS showed low discrimination capacity between patients with and without a CV event. FRS primarily underestimated CV risk at low and intermediate risk levels, and mostly overestimated CV risk at higher risk levels. Table 1. Patients characteristics

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/performance-of-framingham-risk-factor-score-in-predicting-cardiovascular-events-in-patients-with-polymyalgia-rheumatica/