AB0355 CAROTID ULTRASOUND IS MORE EFFECTIVE THAN CORONARY CALCIFICATION ASSESSMENT FOR DETECTING INDICATIONS TO STATIN THERAPY IN RHEUMATOID ARTHRITIS PATIENTS
Authors: Helen Udachkina, Diana Novikova, Tatiana Popkova, Irina Kirillova, Eugenia Markelova, Helen Gerasimova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Objectives</h3> To compare the significance of the carotid ultrasound and the MDCT assessment of coronary calcification in the stratification of cardiovascular risk and the detection of indications for lipid-lowering therapy in patients with RA. <h3>Methods</h3> Ninety two patients with RA are included (ACR/EULAR, 2010), 74% are women, the median of age is 54 [41.5; 60] years, median of disease duration - 6 [5; 21] months, median of DAS28 (ESR) – 5.2 [5.0; 6.0], without cardiovascular diseases and diabetes mellitus, severe chronic renal failure (GFR &lt;60 ml/min x 1.73m<sup>2</sup>). Arterial hypertension was detected in 57% of patients, dyslipidemia – in 50%, 63% of women were in postmenopause. Initially, the cardiovascular risk was assessed using the mSCORE scale, and then again, taking into account the results of carotid ultrasound and MDCT assessment of coronary calcification. <h3>Results</h3> After assessing the cardiovascular risk on the mSCORE scale 41.3% of patients with RA were classified as low risk (n = 38), medium risk – 38% (n = 35), high risk – 15.2% (n = 14), very high risk– 5.5% (n = 5). Non-target lipid levels were detected in 44.7% of low-risk patients, in 83% of medium risk patients, in 78.6% of high risk patients, in 100% of very high risk patient. Absolute indications for statin therapy were detected in 17.4%. Hemodynamically insignificant carotid plaques (stenosis &lt;50%) was detected in 56.5% of patients with RA: in 23.7% of low risk category, in 74.3% of medium risk patients, in 85.7% of high risk patients, in 100% of very high risk patients. A sever calcification of the coronary arteries was detected in 25% (the coronary index is more than 300 U or &gt; 75 percentile of the age- and sex-related reference values, in according to MESA): in 5.3% of low risk patients, in 37% of medium risk patients, in 28.6% of high risk patients, in 80% of very high risk. After carotid ultrasound 38% (34/92) of RA patients were reclassified from the category of low and medium cardiovascular risk on the mSCORE scale to the high risk category. The proportion of patients with high cardiovascular risk increased in 3.5 times (53.2%, p &lt;0.001). There were 42 patients with non-target lipid levels in the high risk category. The proportion of patients with absolute indications for statins increased in 2.9 times compared with the results of the mSCORE evaluation (n = 47/92; 51%; p &lt;0.001). After MDCT assessment of coronary calcification 16.3% (15/92) of RA patients were reclassified from the category of low and medium cardiovascular risk on the mSCORE scale to the high risk category. The proportion of patients with high cardiovascular risk increased in 2.1 times (31.5%, p &lt;0.001). There were 24 patients with non-target lipid levels in the high risk category. The proportion of patients with indications for statins increased in 1.8 times compared with the results of the mSCORE evaluation (n = 29/92; 31.5%; p &lt;0.001). Carotid ultrasound more often reveals indications for statin therapy, p &lt;0.001. <h3>Conclusion</h3> The use of the mSCORE scale is not sensitive enough for stratification of cardiovascular risk in RA patients due to the high incidence of subclinical atherosclerosis in this population. The use of carotid ultrasound and the MDCT assessment of coronary calcification significantly improve the stratification of cardiovascular risk in patients with RA, which helps to identify patients requiring intensive prevention of cardiovascular complications. The frequency of identifying patients with absolute indications for statin therapy when performing carotid ultrasound is significantly higher than MDCT assessment of coronary calcification. <h3>Disclosure of Interests</h3> None declared