Relative Risk Chart Score for the Assessment of the Cardiovascular Risk in Young Patients with Ankylosing Spondylitis

Rueda-Gotor, Javier; Genre, Fernanda; Corrales, Alfonso; Blanco, Ricardo; Fuentevilla, Patricia; Portilla, Virginia; Expósito, Rosa; Arnaiz, C.; Pina, Trinitario; González‐Juanatey, Carlos; Rodríguez‐Rodríguez, Luis

doi:10.1155/2018/1847894

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…The 2016 ESC guidelines proposed the use of a relative risk (RR) chart rather than the traditional SCORE model in patients younger than 50 years. Unlike the SCORE, the RR estimates the relative, not absolute risk, showing the likelihood of developing a fatal CV disease in an individual with traditional CV risk factors compared to another that does not have any risk factors (4,9). This fact constitutes a central point of concern in AS, a disease associated with early atherosclerosis characterized by oxidative stress and inflammation (10,11).…”

Section: Cardiovascular Risk Estimation In Young Patients With Ankylosing Spondylitis: a New Model Based On Amentioning

confidence: 99%

Cardiovascular risk estimation in young patients with ankylosing spondylitis: A new model based on a prospective study in Constanta County, Romania

et al. 2021

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Cardiovascular (CV) risk assessment charts are useful in establishing a patient therapeutic plan, but the most commonly used charts have essential limitations when applied to special populations. Our aim was to determine whether the Systematic Coronary Risk Evaluation (SCORE) chart underestimates the CV risk in young patients with ankylosing spondylitis (AS) and to promote the necessity of new risk assessment models. We conducted a prospective study in Constanta County, Romania including 70 consecutive patients ≤50 years of age, previously diagnosed with AS, without a history of established CV disease, diabetes mellitus and chronic kidney disease. We estimated the CV risk using SCORE based on total cholesterol, applied for a high-risk population, such as the Romanian population. Estimation of CV risk was also conducted with the relative risk (RR) chart, considering the following variables: Smoking, systolic blood pressure and total cholesterol. The majority of patients (n=46, 65.71%) had low risk according to the SCORE chart and only 24 (34.28%) were found to have moderate CV risk; none of them with high or very high CV risk. Ten patients (21.74%) of the 46 who were considered to have a low risk based on the SCORE system presented with carotid plaques. Twelve patients (50%) of the remaining 24 with moderate CV risk were found to have carotid plaques. According to 2016 'European Society of Cardiology' (ESC) guidelines, 22 of all 70 patients were at high/very high CV risk due to the presence of carotid plaques. Comparing the RR chart with carotid plaque detection, only 4 out of 30 (13.3%) patients with RR=1 had carotid plaques; the frequency was higher in those with RR>1. Our results attested that the SCORE system underestimates the risk in patients with carotid plaques. Carotid ultrasound provided a more heightened sensitivity of the RR chart. C-reactive protein (CRP) >3 mg/dl is associated with RR>1, making this chart a better CV risk predictive system in this particular category of patients.

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Section: Cardiovascular Risk Estimation In Young Patients With Ankylosing Spondylitis: a New Model Based On Amentioning

confidence: 99%

Cardiovascular risk estimation in young patients with ankylosing spondylitis: A new model based on a prospective study in Constanta County, Romania

et al. 2021

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“…However, these risk assessments may underestimate the cardiovascular disease risk in patients with AS because nontraditional cardiovascular risk factors are not included. The use of a relative risk chart has also been proposed as an alternative to the Systematic Coronary Risk Evaluation in patients aged < 50 years to determine the risk of cardiovascular disease 48 . Furthermore, the European League Against Rheumatism recommendations advise adapting cardiovascular risk assessments for patients with rheumatoid arthritis with a multiplication factor of 1.5 1 .…”

Section: Comorbidities In Asmentioning

confidence: 99%

“…Screening for asymptomatic atherosclerotic plaques using carotid ultrasound is recommended in patients with rheumatoid arthrits 1 and may be appropriate for patients with AS, especially younger patients 48 . Patients with AS are generally younger than patients with rheumatoid arthritis, and as a result, they may not receive the same cardiovascular screening.…”

Section: Comorbidities In Asmentioning

confidence: 99%

Commentary: Evaluation of the Comorbidity Burden in Patients With Ankylosing Spondylitis Using a Large US Administrative Claims Data Set

Walsh¹,

Song²,

Kim³

et al. 2018

J Cardiol and Cardiovasc Sciences

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Patients with chronic inflammatory rheumatic diseases, such as rheumatoid arthritis and spondyloarthritis, are at a higher risk of comorbidities, including cardiovascular disease. Although the prevalence of spondyloarthritis is estimated to be similar to that of rheumatoid arthritis, the risk of cardiovascular comorbidities in spondyloarthritis is not as well understood. Furthermore, the inflammatory rheumatic diseases differ in their pathogenic mechanisms, the populations affected, and treatment recommendations; therefore, it is important to examine these diseases separately. Ankylosing spondylitis (AS) is the prototype of spondyloarthritis; the onset of disease occurs at a relatively young age, and patients with AS are often undiagnosed for long periods of time. This increased duration of exposure to inflammation and use of nonsteroidal anti-inflammatory drugs may contribute to the higher risk of cardiovascular comorbidities in these patients.Here we describe our recently published study (Walsh JA, et al. Clin Rheumatol. 2018;37[7]:1869-1878.), which used large national claims databases and showed that US patients with AS had significantly more comorbidities, including cardiovascular disease, than matched controls. We also review the current understanding of the risk of cardiovascular comorbidities in patients with AS. Knowledge of the frequency and risk of comorbidities can assist rheumatologists and primary care physicians with comorbidity screening and strategies for a holistic care approach for patients with AS, including the possibility of adapting the existing cardiovascular risk assessments for these patients. Counseling patients on additional lifestyle risk factors, early cardiovascular screening, and the necessity of further diagnostic testing will be important for optimizing patient care for AS. Cardiovascular Disease in Patients With Inflammatory Rheumatic DiseasesPatients with chronic inflammatory rheumatic diseases, such as rheumatic arthritis, spondyloarthritis, and systemic lupus erythematosus, have an increased risk of cardiovascular disease [1][2][3][4][5][6][7][8] . The increased cardiovascular risk in patients with inflammatory rheumatic disease is likely related to systemic inflammation and traditional cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes, smoking, and obesity, some of which are more prevalent in patients with rheumatic diseases. A link between inflammation and accelerated atherosclerosis has been identified in patients with inflammatory rheumatic disease 9-11 . Furthermore, endothelial dysfunction, oxidative stress, macrophage accumulation, toll-like receptor signaling, and proinflammatory cytokines have been implicated in atherogenesis 9,11,12 . Similar to the heterogeneity in

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“…Such extensive cardiovascular involvement or complications of AS are significant public health issues that were easily ignored in previous clinical practice. Accordingly, the development of a predictive chart score [ 18 ] or algorithm for the risk of major adverse cardiovascular events (MACE) in patients with AS based on identified risk factors is important for improving holistic management. Epidemiologic studies establishing risk factors in the demographic, socioeconomic, clinical, immunologic, or pharmacologic domain remain lacking to date.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with the Risk of Major Adverse Cardiovascular Events in Patients with Ankylosing Spondylitis: A Nationwide, Population-Based Case—Control Study

Kao

Wang

et al. 2022

IJERPH

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Background: Potential risk factors for major adverse cardiovascular events (MACE) in patients with ankylosing spondylitis (AS) requiring medical therapy should be investigated. Methods: We identified newly diagnosed AS patients without previous MACE from 2004 to 2012 using the National Health Insurance Research Database, matched MACE cases with non-MACE controls at a 1:4 ratio for age, gender, AS duration, and index date, and included 947 AS patients with MACE and 3896 matched controls for final analyses. By using conditional logistic regression analyses, we examined the associations of MACE with low income, urbanisation, comorbidities, common extra-articular manifestations (EAM), and medications, including nonsteroidal anti-inflammatory drugs (NSAID) of three categories (traditional NSAIDs, selective cyclooxygenase-2 inhibitors (COX-2i), and preferential COX-2is) with their annual cumulative defined daily dose (cDDD) within a year before MACE development. Results: MACE development was associated with the use of selective COX-2is (especially with annual cDDD > 132) and corticosteroids, residence in rural regions, and well-known associated comorbidities, but not with the use of traditional NSAIDs, preferential COX-2i, biologics, methotrexate, sulfasalazine, and common EAMs. Conclusions: The risk factors of MACE in newly diagnosed AS patients include residence in rural regions, well-known associated comorbidities, and the use of corticosteroids and selective COX-2is. A major limitation was the lack of information on individual lifestyle patterns and disease activity.

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Relative Risk Chart Score for the Assessment of the Cardiovascular Risk in Young Patients with Ankylosing Spondylitis

Cited by 8 publications

References 15 publications

Cardiovascular risk estimation in young patients with ankylosing spondylitis: A new model based on a prospective study in Constanta County, Romania

Cardiovascular risk estimation in young patients with ankylosing spondylitis: A new model based on a prospective study in Constanta County, Romania

Commentary: Evaluation of the Comorbidity Burden in Patients With Ankylosing Spondylitis Using a Large US Administrative Claims Data Set

Factors Associated with the Risk of Major Adverse Cardiovascular Events in Patients with Ankylosing Spondylitis: A Nationwide, Population-Based Case—Control Study

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