Reliability of Cardiovascular Risk Calculators to Estimate Accurately the Risk of Cardiovascular Disease in Patients With Sarcoidosis

Abstract

Chronic inflammation is an independent risk factor for cardiovascular disease (CVD) but most risk calculators including Framingham risk score (FRS) and American College of Cardiology (ACC)/American Heart Association (AHA) risk score do not account for it. These calculators underestimate cardiovascular (CV) risk in patients with rheumatoid arthritis and systemic lupus erythematosus. To date, how these scores perform in estimation of CVD risk in patients with sarcoidosis has not been assessed. In this study, FRS and ACC/AHA risk score were calculated for a previously identified cohort of patients with incident cases of sarcoidosis in Olmsted County, Minnesota, United States from 1989 to 2013 as well as their sex and age-matched comparators. The standardized incidence ratio (SIR) was estimated as the ratio of the predicted and observed number of CVD events. All CVD events were identified by diagnosis codes and verified by individual medical record review. The predicted number of CVD events among 188 cases by FRS was 11.8 and the observed number of CVD events was 34, which corresponding to an SIR of 2.88 (95% CI, 2.06 – 4.04). FRS underestimated the risk of CVD events in patients with sarcoidosis by sex, age and severity of sarcoidosis. The predicted number of CVD events among cases by ACC/AHA risk score was 4.6 and the observed number of CVD events was 19, corresponding to an SIR of 4.11 (95% CI, 2.62 – 6.44). In conclusion, FRS and ACC/AHA risk score underestimate the risk of CVD among patients with sarcoidosis.

The Association between Sarcoidosis and Ischemic Heart Disease—A Healthcare Analysis of a Large Israeli Population

“…They also had a 1.58 HR for CAD. Our results revealed that sarcoidosis patients have an adjusted OR of 1.57 for IHD, in line with the results of Ungprasert et al The same group [ 25 ] also evaluated the accuracy of the Framingham risk score and the American College of Cardiology/American Heart Association risk score for CVD in sarcoidosis patients. Both risk scores under-evaluated cardiovascular risk among sarcoidosis patients, possibly since neither addressed chronic inflammatory diseases.…”

Assessing severity of cardiac sarcoid: Is SUV the answer?

“…In fact, both scores significantly underestimate the risk of major adverse cardiac events (MACE) by 2-5 fold, likely reflecting the additional risk conveyed by the acute or chronic inflammatory state (like that seen in rheumatoid arthritis). 2 Furthermore, neither age, the Japanese Ministry for Health & Welfare criteria nor the presence of extra-cardiac sarcoidosis were associated with increased adverse events in a CS cohort. 3 Similarly, baseline ECG abnormalities are of limited benefit in either diagnosis or risk stratification.…”

Navigating the Landscape of Cardiovascular Risk Scores: A Comparative Analysis of Eight Risk Prediction Models in a High-Risk Cohort in Lithuania

“…Likewise, the PCE has been reported to overestimate the risk of CVD in Chinese and underestimate the risk in South Asian American populations [ 19 , 20 ]. In addition, the PCE was shown to underpredict observed events in samples with a lower socioeconomic status or with chronic inflammatory diseases, such as HIV, rheumatoid arthritis, or sarcoidosis [ 21 , 22 , 23 ]. Another large study by Mortensen et al [ 24 ] compared the eligibility criteria for lipid-lowering therapy in the context of primary CVD prevention, utilizing three distinct RPMs: SCORE2, PCE, and QRISK3.…”