Carotid Plaques Predict Cardiovascular Events and Mortality in Patients With Rheumatoid Arthritis

Carotid plaques predict the development of adverse cardiovascular events and mortality in patients with rheumatoid arthritis (RA), according to study results published in Seminars in Arthritis and Rheumatism. Based on study findings, carotid ultrasound assessment may be important for cardiovascular risk stratification in patients with RA.

The study enrolled consecutive patients with RA who received treatment at a general hospital in Santander, Spain, between 2012 and 2013. Eligible patients did not have a history of cardiovascular events, type 2 diabetes mellitus, or chronic kidney disease. Carotid ultrasound was performed at baseline, and 10-year cardiovascular risk was calculated using the 2010 European League Against Rheumatism (EULAR) systematic coronary risk evaluation (mSCORE) for RA, which included patient age, sex, blood pressure, cholesterol, and smoking status. Patients were followed up for 5 years by medical record review. Cox regression was performed to identify baseline predictors of cardiovascular events and death during follow-up. Models were adjusted for age, sex, and disease duration at study entry. Investigators also retrospectively tested the prognostic ability of 2 additional cardiovascular risk algorithms, including the updated mSCORE from 2015/2016 and the QRISK3.

Data from 327 patients were included in analysis, for a total of 1984.25 patient-years of follow-up. The majority of patients were women (n=267; 82%). Mean age and disease duration at study entry were 58.3±13.9 and 9.7±8.3 years, respectively. Mean mSCORE according to the 2010 EULAR recommendations was 1.98±2.48; the retrospectively recalculated 2015/2016 EULAR mSCORE was 2.52±2.96. According to the 2015/2016 EULAR mSCORE (defined as ≥5%), 23 patients (7.0%) were classified as having high or very high cardiovascular risk; however, 146 patients initially classified as having low or moderate risk by the 2015/2016 EULAR mSCORE were reassigned as having  high risk based on the results of their carotid ultrasound assessment. According to the mean QRISK3 score (15.1±13.6), 179 patients were classified as having high or very high cardiovascular risk (defined as QRISK3 ≥10%).

After follow-up, 23 patients died and 27 experienced cardiovascular events. The linearized mortality rate was 1.16 per 100 patient-years. According to the best-fitting regression model for mortality data, carotid plaques (hazard ratio [HR], 6.12 [95% CI, 0.74-50.5]; P =.09) and QRISK3 score (HR, 1.03 [95% CI, 0.99-1.07] for each 1% increase in score; P =.11) were the strongest predictors of death. The best-fitting model for cardiovascular events also identified carotid plaques (HR, 5.13 [95% CI, 1.36-19.3]; P =.02) and QRISK3 score (HR, 1.03 [95% CI, 0.99-1.07] for each 1% increase in score; P =.12) as independent predictors. However, according to all regression models, only carotid plaques were significantly associated with the outcome; QRISK3 score was only nominally predictive of mortality or cardiovascular events. Overall, mSCORE was a weak predictor of death and cardiovascular events in RA.

In a cohort of adults with RA, carotid plaques predicted mortality and cardiovascular events over 5 years of follow-up, with the prognostic capacity of QRISK3 being higher than that of mSCORE. This study represents the first effort to validate QRISK3 in a Spanish population.

“Combination of risk [scores] and noninvasive surrogate markers… may help us to identify those patients with RA who may benefit of intensive therapy to achieve reduction of [cardiovascular] disease,” the investigators wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Corrales A, Vegas-Revenga N, Rueda-Gotor J, et al. Carotid plaques as predictors of cardiovascular events in patients with rheumatoid arthritis. Results from a 5-year-prospective follow-up study [published online May 8, 2020]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2020.03.011