Traditional and disease-related non-computed variables affect algorithms for cardiovascular risk estimation in Sjögren's syndrome and rheumatoid arthritis

Abstract

Objective. Several cardiovascular (CV) risk algorithms are available to predict CV events in the general population. Their performance and validity in rheumatic disease patients is suboptimal as some disease-specific variables which strongly contribute to the pathogenesis of CV disease are not included in these CV algorithms. We aimed to evaluate the performance of two CV algorithms and investigate which variables not included in the score contribute to CV risk score in a cohort of rheumatoid arthritis (RA) and Sjögren's syndrome (SS) patients. Methods. A consecutive cohort of 77 RA and 68 SS patients without prior CV events was included. Clinical and serological features and traditional CV risk factors were collected. The 10-year CV risk was assessed by Reynold Risk Score (RSS) and "Progetto Cuore" algorithms. Results. Prevalence of traditional CV risk factors and 10-year risk of fatal and non-fatal CV events assessed by RSS and "Progetto Cuore" were similar between the two cohorts. Multiple linear regression model showed that, among variables not included in both algorithms, body mass index (BMI) and disease activity were predictors of "Progetto Cuore" while BMI and bone erosions of RSS in RA. In SS, C-reactive protein was predictor of "Progetto Cuore" while hypertension, ESSDAI and LDL-cholesterol of RSS. Conclusion. The 10-year risk of fatal and non-fatal CV events is similar in RA and SS. Traditional CV risk factors, as hypertension, strongly contribute to CV risk in these patients. Inflammatory parameters and disease activity are two disease-specific variables which should be included in CV algorithm assessment in rheumatic disease patients.

Cardiovascular risk in patients with Sjögren's syndrome: is it time for a new approach?

“…Moreover, the knowledge of disease-related parameters significantly contributing as independent variables to CV score in these patients is of paramount importance. In this scenario, the demonstration that systemic inflammation and disease activity contribute as significant independent variables to CV risk score assessed by validated CV algorithms reinforces the hypothesis that algorithms including these variables may perform better in the estimation of 10-year risk of fatal and non-fatal CV events in patients with systemic autoimmune and chronic inflammatory diseases (21). Surely, further prospective studies are needed to identify which CV algorithm has the best predictive performance in these patients and which variables should be included in score calculation.…”

Cardiovascular Involvement in Sjögren’s Syndrome

“…As previously mentioned, these differences can globally be explained by different methodology in terms of patients enrolment and variable definitions. In contrast, it is now well established that smoking is significantly less common among pSS patients compared to the general population but also to patients with other autoimmune diseases, probably due to the worsening of sicca symptoms induced by cigarette smoke ( 30 , 31 ). However, the paucity of data on this topic significantly hamper a full understanding of the picture.…”

Sjögren's syndrome: one year in review 2022

“…The mean 10-year estimated risk of CV events was 4.3 (4.9 SD) % and 4.1 (4.8 SD) % according to RSS and "Progetto Cuore", respectively. Interestingly, both inflammatory parameters, as C reactive protein and ESSDAI, and traditional CV risk factors, namely hypertension and dyslipidaemia, were identified as significant predictors of 10-year CV risk score (61).…”

“…On the other hand, estimation of long-term CV risk in pSS represents an unmet need and the performance of traditional CV algorithms in the disease has never been investigated. A recent study evaluated the performance of two risk algorithms, including the "Progetto Cuore" and the Reynolds Risk Score (RRS), and factors contributing to CV risk score in an Italian cohort of 68 pSS patients free from CV events (61). The mean 10-year estimated risk of CV events was 4.3 (4.9 SD) % and 4.1 (4.8 SD) % according to RSS and "Progetto Cuore", respectively.…”