THU0147 CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS: DO WE ALREADY HAVE A SENSITIVE AND SPECIFIC INSTRUMENT?
Authors: D. Ribeiro, F. Cunha Santos, C. Vaz, J. F. Ferreira
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disorder with high cardiovascular (CV) risk due to both classic and specific disease risk factors. According to EULAR’s recommendations, all patients should carry out an assessment of their CV risk, however, there are no specific evaluation algorithm’s for RA. Objectives: To assess the efficacy to predict CV risk in RA patients using the Systematic Coronary Risk Evaluation model (SCORE), Modified SCORE (mSCORE), Framingham Risk Score (FRS), Modified Framingham Risk Score (mFRS) and the American College of Cardiology/American Heart Association algorithm (ACC/AHA). Methods: Cross-sectional observational study including patients fulfilling 2010 ACR/EULAR classification criteria for RA and followed in the Rheumatology Department at Guarda Local Health Unit. Clinical records were reviewed and sociodemographic, classic CV risk factors and disease related factors, previous history of CV events and current treatment were collected. Individual CV risk was calculated using aforementioned models. Patients were divided in two groups: group 1 (without CV event history) and group 2 (with a history of CV event). Discriminative capacity tests, sensitivity and specificity were asserted and the different models were compared. Results: A total of 107 patients were included in the study and 10 suffered a CV event. Of 107 patients, 78% are women, the average age is 55.97± 6,78 and the average body mass index is 26,44± 4,43 kg/m 2 (Table 1). Models evaluated revealed reasonable discriminative capacity with areas under the curve between 0.73 and 0.88 (Figure 1). Regarding sensitivity and specificity we found that SCORE calculator fail to identified high risk in all patients with a CV event, however it presented a specificity of 94%. Others CV risk calculators showed the following sensitivities and specificities: mSCORE 63%, 88%; ACC/AHA 88%, 84%; FRS 63%, 88%; mFRS 88%, 76%. Table 1. Patient characteristics Patients with RA (N=107 ) Patients with RA without CVD Patients with RA with CVD (N=10 ) p Age (years), mean±SD 56 ± 6,8 55,7 ± 6,9 58,5±5,6 0,240 Female, n(% ) 83 (77,6) 79 (81,4) 4 (40) 0,003 Rheumatoid factor positivity, n(% ) 36 (37,5) 33 (37,9) 3 (33,3) 0,787 Anti-CCP positivity, n (% ) 34 (37) 29 (34,9) 5 (55,6) 0,226 Smoking, n (% ) 4 (3,7) 3 (4,1) 1 (10) 0,031 BMI (weight(Kg)/height(m ) 2 ), mean±SD 26,4±4,4 26,2±4,4 29,7±4,1 0,040 Treatment with statins (% ) 34 28 90 &lt;0,001 Figure 1. Receiver operating characteristic curves of the different risk prediction algorithms Conclusion: The five models tested in this study have a relative discriminative capacity. SCORE did not identify any CV event, which may compromise its ability to assess the CV risk in this patients. The most sensitive and specific model was the ACC/AHA, a very restricted model. When applying the multiplication factor of 1.5 recommended by EULAR, there is an improvement in sensitivity, however the specificity decreases. This study proves the limitations of CV risk calculators designed for the general population when applied to patients with RA. In conclusion, CV risk assessment is extremely important and there is still no ideal calculator, which is both sensitive and specific, and easily applicable in a clinical context. References: [1]Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2016;76(1):17–28. Disclosure of Interests: None declared