Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose: Patients with rheumatoid arthritis (RA) have increased risk of atherosclerotic cardiovascular (CV) disease that is underestimated by the Framingham risk score (FRS). We hypothesized that the new 2013 ACC/AHA 10-year risk score could better identify patients with RA with high coronary artery calcification (CAC) scores, and consequently elevated CV risk, compared to the FRS and the Reynolds risk score (RRS).
Methods: We calculated the 10-year FRS, RRS and ACC/AHA risk score in 98 RA patients aged between 40 and 75 years who would be eligible for risk stratification using the ACC/AHA score and assigned them to either elevated or low risk categories. We identified patients categorized as having elevated CV risk based on the presence of high CAC scores using the thresholds defined by Goff et al. (≥ 300 Agatston units or ≥ 75thpercentile) and compared the ability of the three risk scores to correctly categorize these patients with high CAC as having elevated cardiovascular risk. We used receiver operator characteristic (ROC) curves (or c-statistics) to compare the ability of the three risk scores to identify patients with high CAC.
Results: All three risk scores were higher in patients with high CAC than those without (all P values <0.05). The FRS (32% vs. 16%, P=0.055) and RRS (32% vs. 13%, P=0.018) both assigned more patients with high CAC than low CAC into the elevated risk category. The ACC/AHA risk score assigned more patients with high CAC into the elevated risk category (41%) and also assigned 28% of patients without high CAC into the elevated risk category so that the proportion patients with and without high CAC assigned to the elevated CV risk category was not significantly different (P=0.190). The c-statistics (95% C.I.) for the FRS, RRS and ACC/AHA risk score predicting the presence of high CAC were 0.65 (0.53-0.76), 0.66 (0.55-0.77), and 0.65 (0.53-0.76), respectively.
|
Table: Cardiovascular risk estimates in patients with rheumatoid arthritis with and without high coronary artery calcium |
||||
|
10-year cardiovascular risk scores |
|
CAC<300 agatston units or CAC <75th percentile (n=64) |
CAC≥300 Agatston units or CAC≥75th percentile (n=34) |
P values |
|
Framingham risk score |
Low risk category |
54 (84) |
23 (68) |
0.055 |
|
|
Elevated risk category |
10 (16) |
11 (32) |
|
|
Reynolds risk score |
Low risk category |
56 (87) |
23 (68) |
0.018 |
|
|
Elevated risk category |
8 (13) |
11 (32) |
|
|
ACC/AHA risk score |
Low risk category |
46 (72) |
20 (59) |
0.190 |
|
|
Elevated risk category |
18 (28) |
14 (41) |
|
Conclusion: The new ACC/AHA 10-year risk score, despite classifying more patients with high CAC into the elevated risk category than the FRS and RRS, assigned almost 60% of patients with elevated risk as determined by a high CAC score into the low CV risk category. Modifications of standard CV risk prediction models used in the general population may not improve risk prediction in patients with RA.
Disclosure:
V. K. Kawai,
NIH,
2;
C. P. Chung,
NIH,
2;
J. F. Solus,
None;
A. Oeser,
None;
P. Raggi,
None;
C. M. Stein,
NIH,
2.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-2013-accaha-cardiovascular-risk-prediction-model-and-coronary-atherosclerosis-in-patients-with-rheumatoid-arthritis/