Could cardiovascular disease risk stratification and management in rheumatoid arthritis be enhanced?

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 .…”

“…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 . In view of these considerations, we examined the potential usefulness of chemerin concentrations in CVD risk stratification amongst nonobese patients with RA.…”

Application of the European Society of Cardiology, Adult Treatment Panel III and American College of Cardiology/American Heart Association guidelines for cardiovascular risk management in a French cohort of rheumatoid arthritis

“…Other factors associated with an increased cardiovascular risk in RA are disease duration, rheumatoid factor or anti-cyclic citrullinated peptide (anti-CCP) positivity, severe disease with extraarticular manifestations. How to capture the extra risk beyond the traditional risk factors in clinical practice is a debated issue [8]. Over the course of RA, The European League Against Rheumatism (EULAR) guidelines for the management of cardiovascular risk recommend an annual assessment depending on the SCORE equation or validated national risk equations [9].…”

Subcutaneous nodules are associated with cardiovascular events in patients with rheumatoid arthritis: results from a large US registry

“…It is therefore postulated that the inflammatory state of RA can also lead to accelerated atherosclerosis with associated premature CVD [2]. CVD represents the leading cause of death in RA patients, accounting for approximately one third to one half of all RA-related deaths [3][4][5][6][7]. Epidemiological evidence suggests that Btraditionalô r classic cardiovascular risk factors, such as hypertension, dyslipidemia, insulin resistance, and body composition alterations, are important but insufficient to explain Ball^of the excess risk of CVD in patients with RA [8][9][10][11].…”