Background/Purpose:

Rheumatoid Arthritis (RA) is associated with a greater cardiovascular mortality than the general population of the same age and gender. Cardiovascular events prediction scales, due to its significant dependence on age, underestimate the absolute cardiovascular risk (CVR) in young people. Two methods exist to address this problem: a) Cardiovascular Relative Risk, which estimates the increased risk when compared to people of the same age without CVRF. B) Vascular age, defined as the lower age with the same absolute CVR but with no CVRF. Objective: to evaluate the presence of subclinical carotid atherosclerosis and the utility of the carotid ultrasound (US) in patients with AR under the age of 50 and compare it with relative CVR scores.

Methods:  Transversal prospective study. Patients under 50 years of age who fulfilled the EULAR/ACR 2010 criteria for RA were included. They were selected consecutively when they came on regular follow-up. We registered to calculate SCORE, REGICOR, Relative Cardiovascular Risk and Vascular Age (age, gender, tobacco habits, systolic blood pressure, total serum cholesterol concentration and HDL and diabetes Mellitus) and history of previous CVR event. According to the EULAR 2011 recommendations, a multiplying factor of 1,5 was applied to SCORE, REGICOR and Relative Cardiovascular Risk in patients who fitted in at least two of the following criteria: a) Duration of RA > 10 years, b) positive RF or CCP , c) Presence of extra-articular manifestations. A carotid ultrasound was performed; Intimal medial thickness (IMT) was measured and the presence of atheromatous plaques was assessed. Database and analyzed using SPPSS-Windows 15. Sensitivity and specificity, positive and negative predictive values were calculated.

Results: 83 AR patients under the age of 50 years old were included (71 (85,5%) women) with a mean age of 39 ± 8 years. 61% had RF+ and 50% PCC+. 34% had bone erosion on X-ray and 3.6% presented rheumatoid nodules. About the CVRF: 45% were active smokers; 22% had high blood pressure; 8% were diabetics; 25 had a high LDL levels and 4% presented with hypertriglyceridemia. Regarding to EULAR multiplying factors, 30% had RA duration > 10 years, 69% had CCP or RF+, 13% had extra-articular manifestations, and 27% had 2 or more factors. The prevalence of subclinical carotid pathology was 9.6%. The US results demonstrated that 9.6% (8 patients) had atheromatous plaque (6% unilateral and 4% bilateral). An IMT ≥0, 9 were observed in 1% (1 patient). None of the patients had had a previous history of cardiovascular events. Sensitivity and positive predictive value to identified carotid atheromatous plaques were very low for the modified SCORE and REGICOR, with the exception of the modified RCR, which presented a sensitivity of 87%. Superior specificity was observed with the modified SCORE and REGICOR than with the modified RCR. The negative predictive value was similar in the 3 scales (>90%).

Conclusion:  The prevalence of subclinical atherosclerosis in RA patients under 50 years old is not small (10%). The RCR is the scale with more sensitivity and with an important negative predictive value that allow us to recognize and select the patients for a carotid ultrasound.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-relative-cardiovascular-risk-score-scales-in-patients-under-the-age-of-50-and-its-association-with-the-presence-of-carotid-atherosclerosis-in-the-ultrasound/