CV Risk Scores Underestimate Subclinical Atherosclerosis in Psoriatic Arthritis

CAD, blood clot
CAD, blood clot
Cardiovascular risk assessment tools in patients with PsA have been shown to underestimate the risk for carotid subclinical atherosclerosis.

The use of various established cardiovascular (CV) risk assessment tools in patients with psoriatic arthritis (PsA) has been shown to underestimate the risk for carotid subclinical atherosclerosis (SCA), according to the results of a recent population-based Chinese cohort study published in The Journal of Rheumatology.

Researchers calculated 4 CV predictive risk scores in the study: (1) Framingham Risk Score (FRS), (2) QRISK2, (3) Systematic Coronary Risk Evaluation (SCORE), and  (4) 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD) from the American College of Cardiology and the American Heart Association. They calculated European League Against Rheumatism (EULAR)-recommended modified versions (multiplied by 1.5) for all risk scores labelled with the prefix “m-.” Carotid intima-media thickness >0.9 mm and/or the presence of plaque as detected by ultrasonography were classified as SCA+.

The researchers recruited a total of 146 patients (mean age, 49.4±10.2; 61.6% men) for the study, of whom 142, 137, 128, and 118 were eligible to calculate FRS, QRISK2, SCORE, and ASCVD risk scores, respectively. Overall, 42.5% (62 of 146) of patients were SCA+, significantly older, and had higher systolic blood pressure readings and low-density lipoprotein cholesterol levels (P <.05 for all). 

CV risk scores were all significantly higher in SCA+ individuals vs SCA– individuals: (1) FRS: 7.8, 95% CI, 3.9-16.5 vs 2.7, 95% CI, 1.1-7.8, respectively, P< .001; (2) QRISK2: 5.5, 95% CI, 3.1-10.2 vs 2.9, 95% CI, 1.2-6.3, respectively, P < .001; (3) SCORE: 1, 95% CI, 0-2 vs 0, 95% CI, 0-1, respectively, P <.001; (4) ASCVD: 5.6, 95% CI, 2.6-12.4 vs 3.4, 95% CI, 1.4-6.1, respectively, P =.001).

When preset cutoff values were applied, 44.1% (>10%), 1.8% (>20%), 10.9% (>5%), and 43.6% (>7.5%) of SCA+ patients were identified as being high risk according to FRS, QRISK2, SCORE, and ASCVD risk scores, respectively. 

When the EULAR multiplication factor was used, 50.8%, 14.3%, 14.5%, and 54.5% of patients who were SCA+ were identified as being high risk based on m-FRS, m-QRISK2, m-SCORE, and M-ASCVD, respectively. In fact, the use of EULAR multiplication increased the sensitivity of FRS and ASCVD in distinguishing SCA+ from 44% to 51% and from 44% to 55%, respectively.

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The investigators concluded that FRS, QRISK2, SCORE, and ASCVD may underestimate the risk for SCA in persons with PsA. Use of the EULAR 1.5 multiplication factor was associated with limited improvement in the performance of the 4 CV risk assessment tools. They recommend the development of disease-specific CV risk prediction algorithms.

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Shen J, Lam SH, Shang Q, et al. Underestimation of risk of carotid subclinical atherosclerosis by cardiovascular risk scores in patients with psoriatic arthritis [published online November 15, 2017]. J Rheumatol. doi:10.3899/jrheum.170025.