Rheumatoid Arthritis

Cardiovascular Risk Estimates Vary by Algorithm Used in RA

Rheumatology Advisor Contributing Writer
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Several studies have reported significant reductions in CVD risk in patients with RA treated with conventional synthetic DMARDs or TNF inhibitors.12 Long-term use is associated with further declines in CVD risk, supporting the hypothesis that controlling inflammation reduces CV risk in patients with RA. A recent meta-analysis of clinical trials compared CV outcomes of CVE, MI, stroke, major adverse cardiac events, and congestive heart failure between different classes of anti-rheumatic drugs. Data showed TNF inhibitors significantly reduced the risk of CVE, MI, stroke, and major cardiac events but had a neutral effect on CHF.3 Methotrexate reduced the risk of CVE and MI and had no significant effect on stroke, major adverse cardiac events, or CHF. Nonsteroidal anti-inflammatory drugs significantly increased the risk of CVE and stroke and had a neutral effect on MI, CHF, and major adverse cardiac events. Corticosteroids significantly increased the risk of all CV outcomes assessed.3 Image Credit: Scott Camazine / Science Source
Several studies have reported significant reductions in CVD risk in patients with RA treated with conventional synthetic DMARDs or TNF inhibitors.12 Long-term use is associated with further declines in CVD risk, supporting the hypothesis that controlling inflammation reduces CV risk in patients with RA. A recent meta-analysis of clinical trials compared CV outcomes of CVE, MI, stroke, major adverse cardiac events, and congestive heart failure between different classes of anti-rheumatic drugs. Data showed TNF inhibitors significantly reduced the risk of CVE, MI, stroke, and major cardiac events but had a neutral effect on CHF.3 Methotrexate reduced the risk of CVE and MI and had no significant effect on stroke, major adverse cardiac events, or CHF. Nonsteroidal anti-inflammatory drugs significantly increased the risk of CVE and stroke and had a neutral effect on MI, CHF, and major adverse cardiac events. Corticosteroids significantly increased the risk of all CV outcomes assessed.3 Image Credit: Scott Camazine / Science Source
Researchers in Italy found data that showed the QRISK3-2018 and Progetto Cuore were the most reliable tests to access cardiovascular risk in patients with rheumatoid arthritis.

For patients with rheumatoid arthritis (RA), changes in lipid levels and disease activity affect cardiovascular risk scores differently depending on the algorithm used, according to results published in the Annals of the Rheumatic Diseases.

The study included participants with RA from the BIOlogic aPUlian Registry (BIOPURE) who started a first-line biologic agent since January 2010 (n=112). Participants had all data to calculate the 10-year cardiovascular risk score either at baseline, at 3-month follow-up, or at 6-month follow-up.

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The researchers characterized hyperlipidemia as a total cholesterol ≥240 mg/dL or hypertriglyceridemia >200 mg/dL. They defined hypertension as a systolic blood pressure ≥140 mm Hg and/or a diastolic blood pressure ≥90 mm Hg and/or a diagnosis of hypertension by a clinician. They estimated cardiovascular risk using either the QRISK3-2018 calculator, the Reynold Risk score, the Progetto Cuore Italian score, an adapted algorithm that replicates the Systematic Coronary Risk Evaluation project charts of the European Society of Cardiology, and the Expanded Risk Score in RA.

Of the 112 participants, 86 were women, the mean age was 52.8±12.9 years, and the mean disease duration was 58.6±76.4 months.

After 3 months, total cholesterol levels increased significantly (P =.006), but they returned to baseline levels after 6 months (P =.22). After 6 months, high-density lipoprotein, total cholesterol/high-density lipoprotein ratio, and triglyceride levels did not show significant change.

When the researchers looked at the cardiovascular risk scores, they found varying results depending on the algorithm used. Expanded Risk Score in RA had decreased after only 3 months, with a trend toward decrease that persisted at 6 months. Reynold Risk score showed a decrease only after 6 months. The Progetto Cuore and QRISK3-2018 scores did not change at 3 or 6 months of follow-up.

“Since QRISK3- 2018 and ‘Progetto Cuore’ scores seem not suffer of the changes in Tot-Chol levels and disease activity, they may be used at any time and level of disease activity by rheumatologists in daily clinical practice,” the researchers wrote.

Reference
Fornaro M, Cacciapaglia F, Venerito V, Lopalco G, Iannone F. Influence of changes in cholesterol levels and disease activity on the 10 years cardiovascular risk estimated with different algorithms in rheumatoid arthritis patients [published online May 29, 2019]. Ann Rheum Dis. doi:10.1136/annrheumdis-2019-215715

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