SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis

Abstract

Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ultrasound, has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who had been included in the low or moderate CVD risk categories when the SCORE risk tables were applied. The 2003 SCORE calculator was recently updated to a new prediction model: SCORE2. This new algorithm improves the identification of individuals from the general population at high risk of developing CVD in Europe. Our objective was to compare the predictive capacity between the original SCORE and the new SCORE2 to identify RA patients with subclinical atherosclerosis and, consequently, high risk of CVD. 1168 non-diabetic patients with RA and age > 40 years were recruited. Subclinical atherosclerosis was searched for by carotid ultrasound. The presence of carotid plaque and the carotid intima media wall thickness (cIMT) were evaluated. SCORE and SCORE2 were also calculated. The relationships of SCORE and SCORE2 to each other and to the presence of subclinical carotid atherosclerosis were studied. The correlation between SCORE and SCORE2 was found to be high in patients with RA (Spearman’s Rho = 0.961, p < 0.001). Both SCORE (Spearman’s Rho = 0.524) and SCORE2 (Spearman’s Rho = 0.521) were similarly correlated with cIMT (p = 0.92). Likewise, both calculators showed significant and comparable discriminations for the presence of carotid plaque: SCORE AUC 0.781 (95%CI 0.755–0.807) and SCORE2 AUC 0.774 (95%CI 0.748–0.801). Using SCORE, 80% and 20% of the patients were in the low or moderate and high or very high CVD risk categories, respectively. However, when the same categories were evaluated using SCORE2, the percentages were different (58% and 42%, respectively). Consequently, the number of RA patients included in the high or very high CVD risk categories was significantly higher with SCORE2 compared to the original SCORE. (p < 0.001). In conclusion, although predictive capacity for the presence of carotid plaque is equivalent between SCORE and SCORE2, SCORE2 identifies a significantly higher proportion of patients with RA who are at high or very high risk of CVD.

Lipid profile of postmenopausal women

“…According to the re-evaluation (SCORE2 table) 34% of the respondents pertain to the high risk category, and 8% of the respondents pertain to the very high risk category. 26 As both studies showed significant differences between the percentages of subjects in certain categories, it is certainly necessary to emphasize the need to adapt to the latest guidelines and to change the existing therapy in the subjects in order to achieve the target values of LDL cholesterol. Due to estrogen deficiency, postmenopausal women are at an increased risk of developing cardiovascular diseases, which is certainly influenced by increased waist circumference, hypertension, hypertriglyceridemia, hyperglycemia, and reduced HDL cholesterol values, which are often present.…”

Anti-apolipoprotein A-1 IgG, incident cardiovascular events, and lipid paradox in rheumatoid arthritis

“…Because the prediction of major adverse CV events (MACE) is an unmet clinical need in RA management, numerous initiatives have been undertaken to optimize CV risk stratification in RA using various models combining clinical features, radiological, and/or biomarkers. Unfortunately, proposed models of cardiovascular risk predictions have only resulted in moderated discriminative capacity, with areas under the curve (AUC) in the range of 0.70-0.80, which is why further improvements are deemed necessary (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Von Willebrand Factor and Intima-Media Thickness in Patients With Rheumatoid Arthritis: A Cross-Sectional Study

“…In this regard, well-known risk assessment tools such as the systematic coronary risk evaluation (SCORE) underestimate the actual risk of CVD in RA patients [10]. Thus, there is a significant need for developing optimal methods of assessment and analysis of CVD risk among RA patients.…”