Iván Ferraz-Amaro1, Alfonso Corrales2,3, Juan Carlos Quevedo-Abeledo4, Nuria Vegas-Revenga2,3, Ricardo Blanco2,3, Virginia Portilla2,3, Belén Atienza-Mateo2,3, Miguel Á González-Gay2,3,5. 1. Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain. iferrazamaro@hotmail.com. 2. Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. 3. Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain. 4. Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain. 5. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
BACKGROUND: Previous studies have shown that risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the actual cardiovascular (CV) risk of patients with rheumatoid arthritis (RA). In contrast, carotid ultrasound was found to be useful to identify RA patients at high CV. In the present study, we aimed to determine if specific disease features influence the CV risk reclassification of RA patients assessed by SCORE risk charts and carotid ultrasound. METHODS: 1279 RA patients without previous CV events, diabetes, or chronic kidney disease were studied. Disease characteristics including disease activity scores, CV comorbidity, SCORE calculation, and the presence of carotid plaque by carotid ultrasound were assessed. A multivariable regression analysis was performed to evaluate if the reclassification into very high CV risk category was independently associated with specific features of the disease including disease activity. Additionally, a prediction model for reclassification was constructed in RA patients. RESULTS: After carotid ultrasound assessments, 54% of the patients had carotid plaque and consequently fulfilled definition for very high CV risk. Disease activity was statistically significantly associated with reclassification after fully multivariable analysis. A predictive model containing the presence of dyslipidemia and hypertension, an age exceeding 54 years, and a DAS28-ESR score equal or higher than 2.6 yielded the highest discrimination for reclassification. CONCLUSION: Reclassification into very high CV risk after carotid ultrasound assessment occurs in more than the half of patients with RA. This reclassification can be independently explained by the activity of the disease.
BACKGROUND: Previous studies have shown that risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the actual cardiovascular (CV) risk of patients with rheumatoid arthritis (RA). In contrast, carotid ultrasound was found to be useful to identify RApatients at high CV. In the present study, we aimed to determine if specific disease features influence the CV risk reclassification of RApatients assessed by SCORE risk charts and carotid ultrasound. METHODS: 1279 RApatients without previous CV events, diabetes, or chronic kidney disease were studied. Disease characteristics including disease activity scores, CV comorbidity, SCORE calculation, and the presence of carotid plaque by carotid ultrasound were assessed. A multivariable regression analysis was performed to evaluate if the reclassification into very high CV risk category was independently associated with specific features of the disease including disease activity. Additionally, a prediction model for reclassification was constructed in RApatients. RESULTS: After carotid ultrasound assessments, 54% of the patients had carotid plaque and consequently fulfilled definition for very high CV risk. Disease activity was statistically significantly associated with reclassification after fully multivariable analysis. A predictive model containing the presence of dyslipidemia and hypertension, an age exceeding 54 years, and a DAS28-ESR score equal or higher than 2.6 yielded the highest discrimination for reclassification. CONCLUSION: Reclassification into very high CV risk after carotid ultrasound assessment occurs in more than the half of patients with RA. This reclassification can be independently explained by the activity of the disease.
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Authors: Marta Rojas-Giménez; Clementina López-Medina; María Lourdes Ladehesa-Pineda; María Ángeles Puche-Larrubia; Ignacio Gómez-García; Jerusalem Calvo-Gutiérrez; Pedro Seguí-Azpilcueta; María Del Carmen Ábalos-Aguilera; Desirée Ruíz-Vilchez; Alejandro Escudero-Contreras; Eduardo Collantes-Estévez Journal: J Clin Med Date: 2022-01-27 Impact factor: 4.241
Authors: Marta Rojas-Giménez; Clementina López-Medina; Jerusalem Calvo-Gutiérrez; María Ángeles Puche-Larrubia; Ignacio Gómez-García; Pedro Seguí-Azpilcueta; María Del Carmen Ábalos-Aguilera; Desirée Ruíz; Eduardo Collantes-Estévez; Alejandro Escudero-Contreras Journal: Diagnostics (Basel) Date: 2021-12-28