Discordance of the Framingham cardiovascular risk score and the 2013 American College of Cardiology/American Heart Association risk score in systemic lupus erythematosus and rheumatoid arthritis

Abstract

Despite the increasing use of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular (CV) risk score in clinical practice, few studies have compared this score to the Framingham risk score among rheumatologic patients. We calculated Framingham and 2013 ACC/AHA risk scores in subjects with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and assessed demographic, CV, and rheumatologic characteristics associated with discordant scores (high-risk ACC/AHA scores but low-risk Framingham scores). SLE and RA subjects drawn from two population-based cohort studies were assessed during in-person study visits. We used chi-squared tests and t tests to examine the association of discordant CV risk scores with baseline characteristics. Eleven (7.0%) of 157 SLE subjects and 11 (11.5%) of 96 RA subjects had discordant CV risk scores with high ACC/AHA scores and low Framingham scores. These findings did not significantly change when a 1.5 multiplier was applied to the Framingham score. Rheumatologic disease duration, high-sensitivity CRP levels, African-American race, diabetes, current use of anti-hypertensive medication, higher age, and higher systolic blood pressure were each significantly associated with discordant risk scores. Approximately 10% of SLE and RA subjects had discordant 10-year CV risk scores. Our findings suggest that the use of the 2013 ACC/AHA risk score could result in changes to lipid-lowering therapy recommendations in a significant number of rheumatologic patients. Prospective studies are needed to compare which score better predicts CV events in rheumatologic patients, especially those with risk factors associated with discordant risk scores.

Serum osteopontin negatively impacts on intima‐media thickness in patients with systemic lupus erythematosus

“…Both immunosuppressive treatments and different classes of autoantibodies (eg, antiphospholipid antibodies) might actively contribute to the increased CV risk . SLE should be considered as an independent CV risk factor and the rate of acute events in those patients is twofold higher than estimated by traditional risk models (ie, Framingham and ACC/AHA scores) . On this basis, patients with SLE would generally benefit from additional CV screening and more intensive prevention strategies .…”

“…3 SLE should be considered as an independent CV risk factor and the rate of acute events in those patients is twofold higher than estimated by traditional risk models (ie, Framingham and ACC/AHA scores). 4,5 On this basis, patients with SLE would generally benefit from additional CV screening and more intensive prevention strategies. 6,7 To estimate subclinical atherosclerosis, different non-invasive approaches have been used, including carotid intima-media thickness (cIMT), pulse wave velocity and myocardial perfusion strategies.…”

Atherosclerotic vascular disease in the autoimmune rheumatologic woman

“…The Framingham Risk Score (FRS) and Reynolds Risk Score underestimate 10‐year CVD risk significantly in the RA population . The newer ASCVD 10‐year pooled cohort does appear to reclassify low FRS RA subjects into a higher risk category, but it is unclear if it fully predicts CV event rates . The Systematic Coronary Risk Evaluation, used in Europe, likewise underestimates CV risk .…”

“…47 The newer ASCVD 10-year pooled cohort does appear to reclassify low FRS RA subjects into a higher risk category, but it is unclear if it fully predicts CV event rates. 48 The Systematic Coronary Risk Evaluation, used in Europe, likewise underestimates CV risk. 49 Attempts have been made to include RA in some of these risk algorithms, using the presence of the inflammatory condition along with disease activity/duration to recalculate a risk score.…”

Морфологічні Зміни Серця У Тварин З Експериментальним Системним Червоним Вовчаком

“…Патологія серця при системному чер-воному вовчаку (СЧВ) належить до найчастіших проявів захворювання і багато в чому визначає його прогноз [1][2][3]. У переважній більшості випад-ків СЧВ виявляють зміни систоло-діастолічної функції лівого шлуночка [4,5], а у деяких пацієн-тів також дисфункції правого шлуночка і перед-сердя [6, 7].…”