Poor Performance of Cardiovascular Risk Calculators in Rheumatoid Arthritis

Risk Control
Risk Control
Investigators examined the predictive accuracy of ERS-RA and compared it with a risk calculator without RA-specific risk factors in patients with new-onset RA.

Both the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) and the American College of Cardiology/American Heart Association algorithm (ACC/AHA × 1.5) perform poorly in estimating cardiovascular risk in individuals with rheumatoid arthritis, according to a study recently published in the Journal of Rheumatology.

This study included 665 individuals with incident rheumatoid arthritis, of whom 73 (11%) experienced a cardiovascular event during follow-up. The reported ERS-RA estimated median 10-year risk was 6.3%, while the measured value was 8.3%. Such discrepancies between reported and measured ERS-RA deciles were pronounced throughout the study, though all risk calculators underestimated risk for cardiovascular events. All risk calculators demonstrated good discrimination. High inflammation was associated with an overall poorer level of risk calculator performance, although ACC/AHA × 1.5 demonstrated superior performance in high inflammation. No risk calculator performed well in patients whose estimated risk was between 5% and 15%.

The ACC/AHA was adjusted to the ACC/AHA × 1.5 after recommended adjustments by the European League Against Rheumatism. Variants for ERS-RA included ERS-RA measured, accounting for blood lipids and blood pressure, and ERS-RA reported, accounting for hyperlipidemia and hypertension as reported by patients and physicians. These estimations were compared with recorded events. To calibrate between estimations and observations, deciles were assigned to estimated risk.

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The researchers conclude that “ERS-RA underestimated the risk of a [cardiovascular] event in our cohort of patients, especially when risk estimations were based on patient or physician reports of [hypertension] and hyperlipidemia instead of assessment of [blood pressure] and blood lipids. The performance of ERS-RA was no better than that of ACC/AHA × 1.5, and neither performed well in high-inflammatory patients.”

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Wahlin B, Innala L, Magnusson S, et al. Performance of the expanded cardiovascular risk prediction score for rheumatoid arthritis is not superior to the ACC/AHA risk calculator [published online October 1, 2018]. J Rheumatol. doi: 10.3899/jrheum.171008.