Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms

Arts, Elke; Popa, Călin; Broeder, Alfons A den; Donders, Rogier; Sandoo, Aamer; Toms, Tracey E.; Rollefstad, Silvia; Ikdahl, Eirik; Semb, Anne Grete; Kitas, George D.; Riel, P.L.C.M. van; Fransen, Jaap

doi:10.1136/annrheumdis-2014-206879

Cited by 104 publications

(82 citation statements)

References 33 publications

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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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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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“…Given that these algorithms were not developed in the RA-specific population, the recommendation suggest adjusting the risk to account for the increased CV risk in RA patients [15]. Recent studies reporting RA-specific CV risk calculators have had mixed success in developing an improved CV risk calculator in RA patients [14,16].…”

Section: Introductionmentioning

confidence: 99%

Comparison of cardiovascular risk algorithms in patients with vs without rheumatoid arthritis and the role of C-reactive protein in predicting cardiovascular outcomes in rheumatoid arthritis

et al. 2017

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Objectives. The aims were to compare the performance of cardiovascular risk calculators, Framingham Risk Score (FRS) and QRISK2, in RA and matched non-RA patients and to evaluate whether their performance could be enhanced by the addition of CRP.Methods. We conducted a retrospective analysis, using a clinical practice data set linked to Hospital Episode Statistics (HES) data from the UK. Patients presenting with at least one RA diagnosis code and no prior cardiovascular events were matched to non-RA patients using disease risk scores. The overall performance of the FRS and QRISK2 was compared between cohorts, and assessed with and without CRP in the RA cohort using C-Index, Akaike Information Criterion (AIC) and the net reclassification index (NRI).Results. Four thousand seven hundred and eighty RA patients met the inclusion criteria and were followed for a mean of 3.8 years. The C-Index for the FRS in the non-RA and RA cohort was 0.783 and 0.754 (P < 0.001) and that of the QRISK2 was 0.770 and 0.744 (P < 0.001), respectively. Log[CRP] was positively associated with cardiovascular events, but improvements in the FRS and QRISK2 C-Indices as a result of inclusion of CRP were small, from 0.764 to 0.767 (P = 0.026) for FRS and from 0.764 to 0.765 (P = 0.250) for QRISK2. The NRI was 3.2% (95% CI: À2.8, 5.7%) for FRS and À2.0% (95% CI: À5.8, 4.5%) for QRISK2.Conclusion. The C-Index for the FRS and QRISK2 was significantly better in the non-RA compared with RA patients. The addition of CRP in both equations was not associated with a significant improvement in reclassification based on NRI.Key words: rheumatoid arthritis, cardiovascular, C-reactive protein, risk algorithm, net reclassification index, retrospective, Cox, survival Rheumatology key messages. The Framingham Risk Scores discrimination in the RA population is lower than in the general population. . The inclusion of CRP does not seem to improve reclassification of cardiovascular risk in RA patients.

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“…В связи со сказанным, если эти моде-ли применяются у пациентов с РА, существует вероятность недооценки будущих ССО. Действительно, несколько мо-делей прогнозирования ССЗ неточно предсказывают кар-диоваскулярный риск у пациентов с РА [7,76,77]. В реко-мендациях EULAR 2009 г. для определения кардиоваску-лярного риска был предложен коэффициент умножения 1,5 к расчетному общему риску ССЗ, если пациенты имели два из перечисленных критериев: продолжительность за-Международные и российские рекомендации по лечению ревматических заболеваний болевания >10 лет, позитивность по РФ или АЦЦП и нали-чие внесуставных проявлений [3].…”

Section: рекомендация 4 общий хс (охс) и хс липопротеидов высокой плunclassified

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

Попкова¹,

Новикова²

2018

rsp

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According to the materials of the 2015/2016 new European League Against Rheumatism (EULAR) guidelines for reducing cardiovascular risk in patients with inflammatory arthritis. The authors identify three main principles of prevention of cardiovascular diseases in rheumatoid arthritis and other chronic inflammatory arthritis and provide a general characterization of the guidelines, by reviewing the discussion problems.

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Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms

Cited by 104 publications

References 33 publications

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

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

Comparison of cardiovascular risk algorithms in patients with vs without rheumatoid arthritis and the role of C-reactive protein in predicting cardiovascular outcomes in rheumatoid arthritis

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

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