Carotid ultrasound is useful for the cardiovascular risk stratification of patients with rheumatoid arthritis: results of a population-based study

Abstract

Our results support the use of carotid US in the assessment of CV risk in patients with RA.

Dr. Dessein, et al reply

“…The obtained values and their corresponding sensitivity, specificity, and positive and negative predictive values as determined by applying Bayes theorem 9 are given in Table 1. The optimal cutoff value for the mFramingham score was small at 2.5, which is in keeping with the reported observation that applying multiple major traditional risk factor assessment equations as recommended in the population at large results in a gross underestimation of plaque presence in RA 6,7 . Both the corresponding specificity and negative predictive values for the mFramingham score, as well as chemerin concentrations, were relatively large at 71.2% and 75.1%, and 72.9% and 68.2%, respectively, suggesting that patients with nonelevation of these measures are unlikely to experience high-risk atherosclerosis.…”

“…These entailed the use of multiple major traditional risk factor assessment equations such as the Framingham score and the systematic coronary risk evaluation score (SCORE), with the additional application of a multiplier of 1.5 in patients with RA who met 2 of 3 criteria consisting of (1) a disease duration > 10 years, (2) rheumatoid factor or anticyclic citrullinated peptide positivity, and (3) the presence of extraarticular manifestation, thereby creating the modified Framingham (mFramingham) and mSCORE. However, a large proportion of patients with RA without an estimated high CVD risk according to the mSCORE were recently found to have carotid artery plaque, which represents very high risk, and therefore an indication for lipid-lowering intervention 6,7 . These findings call for the use of additional risk assessment tools including vascular imaging, as well as cardiovascular risk biomarkers in RA 7 .…”

According to the Materials of the 2015/2016 New European League Against Rheumatism (Eular) Guidelines for Reducing Cardiovascular Risk in Patients With Inflammatory Arthritis: General Characterization and Discussion Problems

“…В этих рекомендациях аутоиммунные заболевания (РА, сис-темная красная волчанка и псориаз) признаны заболевания-ми с повышенным кардиоваскулярным риском [6]. Исполь-зование дуплексного сканирования сонных артерий позво-ляет реклассифицировать значительную часть пациентов с РА в более высокую группу риска ССЗ [86]. Таким образом, в связи с высокой претестовой вероятностью выявления АТБ сонных артерий у пациентов с РА и клинической важности их выявления (определяет инициацию терапии статинами) проведение дуплексного сканирования сонных артерий крайне целесообразно для оценки риска ССЗ.…”

Vitamin D Replacement Therapy: A Promising Adjunct in Cardiovascular Risk Management Among Patients with Rheumatoid Arthritis?

“…RA results in enhanced endothelial activation and atherosclerosis that translate into a markedly increased risk of CVD events 6,7 . The identification of potential determinants of enhanced atherogenesis in RA is currently the subject of intensive investigation: to date, high-grade systemic inflammation and corticosteroid therapy were found to induce adverse metabolic risk factor profiles including insulin resistance, a direct effect of inflammatory molecules on endothelial activation; and genetic factors were found to enhance CVD risk in this disease 6,7 .…”

“…The identification of potential determinants of enhanced atherogenesis in RA is currently the subject of intensive investigation: to date, high-grade systemic inflammation and corticosteroid therapy were found to induce adverse metabolic risk factor profiles including insulin resistance, a direct effect of inflammatory molecules on endothelial activation; and genetic factors were found to enhance CVD risk in this disease 6,7 . Consideration of only traditional risk factors results in a large underestimation of the proportion of patients with RA who are at high risk of CVD events evidenced by the presence of carotid artery plaque, and who will therefore need intensive CV risk management 7 .…”