Fri0037 diagnostic Performance of Current CVR Scores for the Diagnosis of Carotid Plaque in Mexican-Mestizo Ra Subjects

Abstract

Background:Rheumatoid arthritis (RA) is an inflammatory disease with an increased mortality compared to the general population. The measurement of carotid intima media thickness (CIMT) is used as an independent marker of subclinical atherosclerosis.Objectives:To determine the prevalence of carotid plaque (CP) in a cohort of Mexican RA subjects and diagnostic performance of cardiovascular risk (CVR) calculators for the prediction of augmented CIMT and CP.Methods:A cross-sectional study of subjects aged from 40-75 years that fulfilled the 2010 ACR/EULAR RA criteria. Exclusion criteria: previous CV disease and overlap syndromes. CVR was calculated by 6 scales: ACC/AHA 2013, Framingham-lipids (FRS-lipids), Framingham-Body Mass Index (FRS-BMI), Reynolds Risk Score (RRS), QRISK2 and SCORE. Carotid ultrasound (US) was performed by a board-certified radiologist and reviewed by other two. We defined an augmented CIMT as ≥0.9 mm and CP as CIMT ≥1.2 mm. We categorized subjects in 3 groups: 1) normal carotid US, 2) augmented CIMT, and 3) CP. We used Kruskal-Wallis test to compare the groups.Results:130 patients were included, 124 (95.4%) were females with median age of 57 years old and disease duration of 9.7 years. Almost 50% of the subjects with CP were in the low-risk strata of every CVR calculator. The presence of CP was higher in subjects categorized as moderate/high risk using ACC/AHA 2013 CVR score (p=0.013), moderate/high risk strata of QRISK2 (p=0.004), and high-risk strata of ACC/AHA 2013 CVR score (p=0.02). Of these 3, the highest sensitivity was obtained by the moderate risk stratum of QRISK2 with 51%; the highest specificity was obtained by the high-risk stratum of the ACC/AHA 2013 CVR score with 84%.Table 1Comparison groups CP presence N=39 CIMT ≥0.9mm N= 29 Normal CIMT N= 62 p Age years59 (55-66)60 (53-70)51 (44-58) 0.00 BMI kg/m2 27.3 (25.3-29.9)27.8 (24.7-31.3)29.9 (26.6-34.5) 0.022 ACC/AHA 20134.6 (2.3-10.2)5.6 (2.2-11.8)1.7 (0.7-3.5) 0.00 FRS-LIPIDS7.1 (5.3-10.3)9.25 (6.1-13.4)3.8 (2.1-6.1) 0.00 FRS-BMI10.4 (7.7-15.4)12.2 (8.7-21.6)4.8 (2.7-9.3) 0.00 SCORE1 (0.5-2)1 (0-2)0 (0-1) 0.00 QRISK210.5 (5.2-16.7)11.6 (5.6-17.1)3.1 (1.9-6.3) 0.00 RRS2 (1.3-4)3 (1-5.7)1 (1-2) 0.00 Variables reported as median, (q25 - q75)Table 2.Diagnostic test performance CVR score moderate and high risk CP (n=39) No CP (n=91) p HR (95% CI) Sens (%) Spec (%) PPV (%) NPV (%) ACC/AHA 2013, n (%)19 (48.7)24 (26.4) 0.01 2.6 (1.2-5.7) 0.480.730.440.77FRS-Lipids, n (%)11 (28.2)17 (18.7)0.221.71 (0.7-4)0.280.810.390.72FRS-BMI, n (%)20 (51.3)31 (34.1)0.062.03 (0.9-4.3)0.510.650.390.75QRISK2, n (%)20 (51.3)23 (25.3) 0.00 3.1 (1.4-6.8) 0.510.740.460.78RRS, n (%)2 (5.1)2 (2.2)0.372.4 (0.3-17.7)0.050.970.500.70Conclusion:Increased CIMT or CP might be unidentified if the risk is exclusively determined by CVR calculators. Patients with a CIMT ≥0.9 mm had an average score that placed them in the low risk strata, leading to an underestimation of their real CVR. Calculators can be helpful to estimate the CVR, however, they don’t seem...

Challenges in Implementing Cardiovascular Risk Scores for Assessment of Young People With Childhood-Onset Autoimmune Rheumatic Conditions

“…Another study, published only as an abstract, investigated the accuracy of 6 different CVR scores (FRS-lipids, FRS-BMI, RRS, QRISK2, and SCORE) in a cohort of 130 RA patients, age 40–75 screened for the presence of carotid plaque (50% had plaque on ultrasound examination), and found that the presence of plaque was higher in patients classified as moderate/high risk using ASCVD and QRISK2 scores ( 53 ).…”