medwireNews: Combining the QRISK3 and the EULAR modified systematic coronary risk evaluation (mSCORE) algorithms may optimize identification of people with rheumatoid arthritis (RA) at high risk for carotid plaques, research suggests.
Miguel González-Gay (Hospital Universitario Marqués de Valdecilla, Santander, Spain) and colleagues explain that although carotid plaques may predict the development of cardiovascular (CV) events in people with RA, carotid ultrasound assessment is not routinely available in outpatient rheumatology clinics.
“In these cases, clinicians have to rely on CV risk algorithms adapted from those of the general population,” the researchers say.
They investigated the ability of two such algorithms – QRISK3 and the EULAR mSCORE – to predict the presence of carotid plaques in 865 people with RA (mean age 57 years, 77% women) who had no history of diabetes, chronic kidney disease, or CV events. Of these, 54% had carotid plaques on carotid ultrasound assessment.
Using cutoffs of 10% for QRISK3 and 5% for EULAR mSCORE, the researchers grouped the patients into those with low to moderate or high to very high CV risk.
In total, 422 patients fell below the cutoff for both algorithms, 135 of whom had carotid plaques, resulting in a sensitivity for plaque prediction of 32% for these patients.
No patient had a low to moderate QRISK3 and a high EULAR mSCORE, but 376 had a high QRISK3 and a low EULAR mSCORE. Of these, 275 had a carotid plaque, giving a sensitivity of 73.2%.
This sensitivity increased to 83.3% when the scores for both algorithms were at or above the high-risk thresholds; 66 patients fell into this category, 55 of whom had carotid plaques.
Compared with a low-risk score for both categories, the diagnostic odds ratio for carotid plaques was a significant 5.79 when QRISK3 was high or very high and EULAR mSCORE was low or moderate, and a significant 10.6 when the scores were high or very high for both algorithms.
González-Gay and team also calculated that each 1% increase in QRISK3 was associated with a significant 14% increased likelihood of having carotid plaques, while each 1% increase in EULAR mSCORE was associated with a significant 22% increased likelihood.
Writing in Rheumatology, the authors conclude: “The present study demonstrates that the combined use of QRISK3 and mSCORE may provide useful information, almost similar to that reported by the carotid [ultrasound] assessment.”
They add: “Therefore, we proposed the combined use of both risk algorithms in RA to identify individuals at high CV risk when noninvasive surrogate markers are not available.”
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Rheumatology 2020; doi:10.1093/rheumatology/keaa718/6010290