Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries

Crowson, Cynthia S.; Gabriel, Sherine E.; Semb, Anne Grete; Riel, P.L.C.M. van; Karpouzas, George; Dessein, Patrick H; Hitchon, Carol; Pascual‐Ramos, Virginia; Kitas, George D.; Douglas, Karen; Sandoo, Aamer; Rollefstad, Silvia; Ikdahl, Eirik; Kvien, Tore K; Arts, Elke; Fransen, Jaap; Tsang, Leo Leung-Chit; El‐Gabalawy, Hani; Yáñez, Irazú Contreras; Matteson, Eric L.; Rantapää‐Dahlqvist, Solbritt; Wållberg‐Jonsson, Solveig; Innala, Lena; Sfikakis, Petros P.; Zampeli, Evangelia; González-Gay, Miguel Á.; Corrales, Alfonso; Laar, Mart van de; Vonkeman, Harald E.; Meek, I.; Husni, Elaine; Overman, Robert A.; Colunga, Iris; Galarza, Dionicio

doi:10.1093/rheumatology/kex038

Cited by 117 publications

(68 citation statements)

References 24 publications

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“…The 10‐year risk of cardiovascular disease from the Framingham Heart Study was used to determine cardiovascular risk in our study population. Although RA‐specific cardiovascular risk algorithms have been developed over the last years, their clinical utility is still debatable, as they do not seem to predict cardiovascular risk more accurately in patients with RA, compared to the general population cardiovascular risk calculators, including Framingham Risk Score . The 10‐year general cardiovascular risk was calculated using the relevant calculator from the Framingham Heart Study based on sex, age, systolic blood pressure, treatment for hypertension, smoking, diabetes, HDL and total cholesterol levels …”

Section: Methodsmentioning

confidence: 99%

Retinal vessel morphology in rheumatoid arthritis: Association with systemic inflammation, subclinical atherosclerosis, and cardiovascular risk

et al. 2017

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Section: Methodsmentioning

confidence: 99%

Retinal vessel morphology in rheumatoid arthritis: Association with systemic inflammation, subclinical atherosclerosis, and cardiovascular risk

et al. 2017

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“…However, traditional cardiovascular risk models including the Systematic Coronary Risk Evaluation (SCORE), Framingham risk score (FRS), Reynolds risk score (RRS), and 2013 American College of Cardiology/American Heart Association CVD Risk Score do not sufficiently stratify rheumatoid arthritis patients according to risk 147148149. Efforts have been made to develop novel cardiovascular disease risk models for use in rheumatoid arthritis,150151 or to modify existing models with a correction factor for rheumatoid arthritis,152 but these novel indices failed to outperform general population models in limited external validation testing 151153. Further assessments of these models will be critical to determining the optimal risk model for regular clinical use.…”

Section: Management and Prevention Of Cardiovascular Disease In Rheummentioning

confidence: 99%

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

England

Thiele

Anderson

et al. 2018

BMJ

398

266

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Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.

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“…Moreover, patients with RA with cardiovascular disease may not have symptoms [48,70,71]. Using the classic Framingham risk equation (based on age, sex, total cholesterol level, high density lipoprotein cholesterol level, smoking history, and systolic blood pressure), patients with RA, SPA, and SLE may fall into a low risk category, leading some to add the presence of a systemic inflammatory disease such as RA, SPA, and SLE to the list of traditional cardiovascular risk factors, or to add a multiplication factor of 1.4 to the calculation of cardiac risk, recognizing that the current risk assessment tools are unreliable and underestimate cardiac risk in patients with RA, SPA, and SLE [51,[72][73][74][75][76]. Major orthopedic surgery is categorized as an intermediate risk procedure in the ACA/AHA guideline, and carries a 1-5% risk of MI or cardiovascular death [68].…”

Section: Major Acute Cardiac Eventsmentioning

confidence: 99%

Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review

Goodman

Bass

2018

BMC Rheumatol

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Total hip (THA) and total knee arthroplasty (TKA) are widely used, successful procedures for symptomatic end stage arthritis of the hips or knees, but patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SPA) including ankylosing spondylitis (AS) and psoriatic arthritis (PSA) are at higher risk for adverse events after surgery. Utilization rates of THA and TKA remain high for patients with RA, and rates of arthroplasty have increased for patients with SLE and SPA. However, complications such as infection are increased for patients with SLE, RA, and SPA, most of whom are receiving potent immunosuppressant medications and glucocorticoids at the time of surgery. Patients with SLE and AS are also at increased risk for perioperative cardiac and venous thromboembolism (VTE), while RA patients do not have an increase in perioperative cardiac or VTE risk, despite an overall increase in VTE and cardiac disease. This narrative review will discuss the areas of heightened risk for patients with RA, SLE, and SPA, and the perioperative management strategies currently used to minimize the risks.

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Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries

Abstract: The QRISK2, EULAR multiplier and ERS-RA algorithms did not predict CVD risk more accurately in patients with RA than CVD risk calculators developed for the general population.

Cited by 117 publications

References 24 publications

Retinal vessel morphology in rheumatoid arthritis: Association with systemic inflammation, subclinical atherosclerosis, and cardiovascular risk

Retinal vessel morphology in rheumatoid arthritis: Association with systemic inflammation, subclinical atherosclerosis, and cardiovascular risk

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review

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