Combined Use of Risk Algorithms Predicts Carotid Plaques in Patients With Rheumatoid Arthritis

The combined use of the European League Against Rheumatism (EULAR) modified systemic coronary risk evaluation (mSCORE) and the QRISK3 algorithms predicts carotid plaques in patients with rheumatoid arthritis (RA), according to study results published in Rheumatology.

Previous studies have shown that carotid plaques are important predictors of cardiovascular events in patients with RA. The QRISK3 algorithm is used to assess the risk for myocardial infarction or stroke in the following 10 years, while SCORE is used to determine the risk for fatal cardiovascular events within the 10 years.

The objective of the current study was to determine whether the combination of QRISK3 and mSCORE will allow for better identification of carotid plaques in patients with RA.

The study sample included Spanish patients with RA without a history of diabetes, chronic kidney disease, or prior cardiovascular events, including ischemic heart disease, cerebrovascular accident, peripheral arterial disease, or heart failure. The mSCORE for RA, based on the 2015/2016 updated EULAR recommendations, and the QRISK3 algorithms were retrospectively tested using baseline data obtained at the time of the carotid ultrasound assessment.

Researchers included 865 patients with RA (77% women; mean age, 57.25 years; mean disease duration, 7.6 years) assessed by carotid ultrasonography. Of these patients, 466 (54%) were found to have carotid plaques on ultrasound, of whom 301 had bilateral plaques.

In patients with QRISK3 less than 10%, the sensitivity to identify carotid plaques was low; however, in 73.2% (95% CI, 68.4%-77.6%) of patients with QRISK of 10% or more and mSCORE less than 5%, there was evidence for carotid plaques (diagnostic odds ratio, 5.79; 95% CI, 4.14-8.10). The sensitivity was 83.3% (95% CI, 72.1%-91.4%) when both algorithms were above their respective thresholds of high cardiovascular risk (diagnostic odds ratio, 10.6; 95% CI, 5.13-22.0).

When both QRISK3 and mSCORE scales were used as continuous variables, they were positively associated with carotid plaque. Researchers observed a 1.14-fold increased risk for carotid plaque for each 1% QRISK increase and a 1.22-fold increased risk for each 1% mSCORE increase. However, the effects of both algorithms did not multiply by each other.

Researchers noted that QRISK3 and SCORE are used to predict cardiovascular events or mortality and not carotid plaques, which was an important limitation of the study.

“We proposed the combined use of both risk algorithms in RA to identify individuals at high [cardiovascular] risk when noninvasive surrogate markers are not available,” the researchers concluded.

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, Atienza-Mateo B, et al. Combined use of QRISK3 and SCORE as predictors of carotid plaques in patients with rheumatoid arthritis. Rheumatology. Published online November 30, 2020. doi:10.1093/rheumatology/keaa718