SAT0309 Underestimation of cardiovascular events by cardiovascular risk scores in psoriatic arthritis patients
Authors: H.M. Lam, S.H.O. Ngai, S.H. Cho, T.K. Chun, K.L. Kot, C.T. Yim, E.F. Yu, E.W.L. Kun, L.S. Tam
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Compared with the general population, patients with Psoriatic Arthritis (PsA) have elevated risks of developing cardiovascular diseases (CVD). The performances of established CVD risk scores in PsA patients have not been fully evaluated yet. European League Against Rheumatism (EULAR) recommends a 1.5 multiplication factor to these CVD risk scores when it is applied in rheumatoid arthritis patients. Whether the same multiplication factor could improve the performance of the risk scores in PsA patients is unknown. <h3>Objectives</h3> To investigate the performances of various CVD risk scores and their EULAR modified versions for predicting CVD events in PsA patients <h3>Methods</h3> Prospectively collected data from the two Hong Kong PsA cohort was used. Discriminatory ability for CV risk prediction was estimated by the area under the receiver operating characteristic curve (AUC). Four different CVD risk scores namely Framingham risk score (FRS), QRISK II, HeartScore and American College of Cardiology and American Heart Association (ACC/AHA) 10 year atherosclerotic cardiovascular disease (ASCVD) and their EULAR modified versions were calculated at baseline. The primary outcome was first CVD events, including stable and unstable angina, myocardial infarction, ischaemic and haemorrhagic stroke, transient ischaemic attack, heart failure, coronary insufficiency, pericardial disease, peripheral arterial disease, thrombosis, percutaneous coronary intervention (angioplasty), coronary artery bypass graft, implantation of pacemaker or defibrillator and CVD death. <h3>Results</h3> 228 patients [48.9±11.8 years, male: 124 (54.4%)] were recruited between 2006 to 2016. Baseline data were available from 227, 226, 226 and 188 patients to calculate the FRS, QRISKII, HeartScore and ASCVD, respectively. After a mean follow up of 6.7±4.7 years, 30 patients (13.2%) experienced a CVD event (CVD +group). At baseline, the CVD +group was significantly older (57.8±12.0 vs 47.6±11.2 years; p&lt;0.001), with a higher prevalence of diabetes (26% vs 12%; p&lt;0.021), had higher systolic blood pressure (SBP: 142±22.0 vs 128±19.6 mmHg; p&lt;0.001) and higher triglycerides (TG: 1.9±1.3 vs 1.4±0.8 mmol/L, p=0.027). All CVD risk scores were significantly higher in the CVD +group (FRS: 18.3±13.1 vs 8.9±8.7, p&lt;0.001; QRISKII: 11.9±8.6 vs 4.9±5.0, p&lt;0.001; HeartScore: 2.3±2.1 vs 0.9±1.3, p=0.001; ASCVD: 14.5±12.8 vs 4.8±5.2, p=0.001). AUC for FRS, QRISKII, HeartScore and ASCVD were 0.74 (0.64–0.83, p&lt;0.001), 0.76 (0.66–0.86, p&lt;0.001), 0.72 (0.62–0.83, p<i>&lt;</i>0.001), and 0.77 (0.67–0.86, p<i>&lt;</i>0.001), respectively. In total, 76 (33.5%), 9(4.0%), 7 (3.1%) and 47 (25.0%) patients were classified as high CVD risk according to FRS &gt;10%, QRISK II&gt;20%, HeartScore &gt;5% and ASCVD &gt;7.5% respectively. In the CVD +group, those identified as high risk were only 63% (by FRS), 20% (by QRISK2), 13.3% (by HeartScore) and 46% (by ASCVD) (figure1a). By applying the EULAR multiplication factor, 80%, 36%, 26.67% and 56.7% of the patients with CVD +were reclassified as high risk (figure1b). <h3>Conclusions</h3> All CVD risk scores significantly underestimated CVD risks among PsA patients. This study demonstrated for the first time that adaptation of the EULAR recommendation only improved the accuracy of FRS to a moderate level. <h3>Disclosure of Interest</h3> None declared