Background/Purpose: An increased incidence of cardiovascular (CV) mortality has been reported in patients with rheumatoid arthritis (RA). Adequate stratification of the CV risk is an issue of major importance in these patients. Objective:To compare the CV risk estimated by a traditional score with carotid ultrasound (US) assessment in RA patients. 

Methods: A cross-sectional study including RA patients without history of CV events was designed. Data collected included clinical and demographic characteristics. All patients were evaluated for traditional CV risk factors. CV risk was stratified according to Framingham Score. Carotid US was performed to assess the presence of subclinical atherosclerosis. The presence of cIMT >0.90 mm and/or carotid plaques (US Carotid Atherosclerosis=UCA) were considered a marker of CV high risk. The association between clinical characteristics and US findings was assessed using univariate and multivariate analysis. ROC curves were developed to estimate cut-off values.

Results: We included 60 patients with RA. Mean age was 54.2±12.3 years, and 78% were female. Mean disease duration was 13±9 years, and mean DAS28 was 3.8±1.17. All patients were receiving DMARDs, 36% biologic treatment and 58% oral steroids (mean dose: 6.22±2.3). Eleven patients (18%) had hypertension, 16 (26,7%) dyslipidemia and 28 (46%) were exposed to tobacco (pack/year mean:10.8±7.4). The Framingham median score was 6.05 (IQR:3.4-10.2); 45 (75%), 10 (16.7%) and 5 (8.3%) patients were classified as low, moderate and high CV risk, respectively. US assessment detected UCA (plaque and/or cIMT >0.90) in 33 (55%) patients, plaques in 30 (50%), and cIMT >0.90 in 18 (30%). The UCA frequencies observed in the different Framingham categories were: Low: 20/45 (44.4%), Moderate: 8/10 (80%), High: 5/5 (100%). In the univariated analysis the presence of UCA was more frequent in older patients (p<0.0001) and with longer disease duration (p=0.057). After adjusting for multiple confounders age was the only variable that remained associated with UCA. In the ROC analysis the optimal cutoff value for age, that predicts UCA presence  was 53.5 years with a sensitivity and specificity of 84.8% and 81.5%, respectively (AUC: 0.89).The UCA prevalence was 84.8% (n = 28) in patients with age ≥53.5 years, compared to only 15.2% (n = 5) in those with age <53.5 years.

Conclusion: More than a half of patients classified in low-moderate risk according to Framingham score presented subclinical atherosclerosis in carotid US assessment. A large majority of patients older than 53.5 years showed high-risk carotid involvement, which may require intensive CV risk management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/traditional-risk-score-underestimates-the-cardiovascular-risk-in-rheumatoid-arthritis-patients/