Predictive Utility of Cardiovascular Risk Prediction Algorithms in Inflammatory Rheumatic Diseases: A Systematic Review

Abstract

Objective.We performed a systematic review of the literature to describe current knowledge of cardiovascular (CV) risk prediction algorithms in rheumatic diseases.Methods.A systematic search of MEDLINE, EMBASE, and Cochrane Central databases was performed. The search was restricted to original publications in English, had to include clinical CV events as study outcomes, assess the predictive properties of at least 1 CV risk prediction algorithm, and include patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), or psoriasis. By design, only cohort studies that followed participants for CV events were selected.Results.Eleven of 146 identified manuscripts were included. Studies evaluated the predictive performance of the Framingham Risk Score, QRISK2, Systematic Coronary Risk Evaluation (SCORE), Reynolds Risk Score, American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE), Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), and the Italian Progetto CUORE score. Approaches to improve predictive performance of general risk algorithms in patients with RA included the use of multipliers, biomarkers, disease-specific variables, or a combination of these to modify or develop an algorithm. In both SLE and PsA patients, multipliers were applied to general risk algorithms. In studies of RA and SLE patients, efforts to include nontraditional risk factors, disease-related variables, multipliers, and biomarkers largely failed to substantially improve risk estimates.Conclusion.Our study confirmed that general risk algorithms mostly underestimate and at times overestimate CV risk in rheumatic patients. We did not find studies that evaluated models for psoriasis or AS, which further demonstrates a need for research in these populations.

A Panel of Biomarkers Associates With Increased Risk for Cardiovascular Events in Women With Systemic Lupus Erythematosus

“…In one Canadian cohort study, the relative risk was 10.1 for MI and 7.9 for stroke even after controlling for traditional Framingham risk factors (2). More recently, a systematic review of risk algorithms in rheumatic diseases found that most models underestimated the cardiovascular risk in SLE and rheumatoid arthritis (RA) (6). The few studies that examined the addition of biomarkers to a traditional risk factor panel in patients with rheumatic disease have largely demonstrated no improvement in predictive capacity.…”

Usefulness of CHA2DS2‐VASc score to predict mortality and hospitalization in patients with inflammatory arthritis

“…Disappointingly, this is also true for the long‐term prediction for adverse clinical events because established risk models such as Systematic Coronary Risk Evaluation score, Framingham Risk Score, Reynolds risk score, generally and largely underestimate CV risk . Recently, Colaco et al performed a systematic review of the literature to describe current knowledge of CV risk prediction algorithms in rheumatic diseases. They confirmed that general risk algorithms mostly underestimate and at times overestimate cardiovascular risk in rheumatic patients.…”

Impact of the Uncoupling Protein 1 on Cardiovascular Risk in Patients with Rheumatoid Arthritis

“…To study if UCP1 transcription contributes to CV morbidity, we estimated the risk to develop or die of CV disease by using the Pocock’s and Framingham risk models [ 31 , 32 ]. As a consequence of adverse metabolic profile and serum lipid levels, both UCP1+ groups had somewhat higher CV risk compared to other patients.…”

“…Estimation of CV risk in patients with RA often meets difficulties. Traditional prediction models provide only partial explanation to the well-documented premature CV mortality in RA patients [ 32 ]. Persistent disease activity and excess of inflammation initiated by cytokines has been postulated central for development of vascular pathology in RA [ 33 ].…”