Top

02-07-2018 | Rheumatoid arthritis | Article

The best cardiovascular risk calculator to predict carotid plaques in rheumatoid arthritis patients

Journal: Clinical Rheumatology

Authors: Martin I. Wah-Suarez, Dionicio A. Galarza-Delgado, Jose R. Azpiri-Lopez, Iris J. Colunga-Pedraza, Jesus Alberto Cardenas-de la Garza, Raymundo Vera-Pineda, Rosa I. Arvizu-Rivera, Adrian Martinez-Moreno, Ray E. Ramos-Cazares, Elizabeth E. Abundis-Marquez, Andres H. Guillen-Lozoya, Jose A. Davila-Jimenez, Cinthia Y. Guillen-Gutierrez, Guillermo Elizondo-Riojas

Publisher: Springer London

Abstract

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors increase cardiovascular risk (CVR) in these patients. Several CVR calculators are used in general population and in RA patients to predict cardiovascular outcomes and tailor therapy but the precision of these calculators in RA patients has yet to be determined. The aim of this study is to determine which risk calculator correlates best with carotid ultrasound (US) findings, specifically carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without clinical manifestations. This was a cross-sectional observational study relating CVR scores in RA patients with the presence of carotid US findings. A total of 97 patients 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were selected. Clinical assessment of cardiovascular risk was performed using seven calculators and carotid US measurement of intima-media thickness and plaque. The tests with the highest sensitivity for CIMT were the Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2. In CP, the highest sensitivity was in QRISK2, SCORE, and ACC/AHA 2013. RA patients should be comprehensively evaluated to detect cardiovascular risk. Carotid US may be routinely recommended to detect subclinical atherosclerosis in RA patients. A lower cutoff point in CVR scales may be necessary to identify patients with a low and intermediate CVR to detect subclinical atherosclerosis earlier and personalize therapy.

Ross R (1999) Inflammation or atherogenesis. N Engl J Med 340(2):115–126. https://doi.org/10.1056/NEJM199901143400207 CrossRefPubMed

Myasoedova E, Chandran A, Ilhan B, Major BT, Michet CJ, Matteson EL, Crowson CS (2016) The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease. Ann Rheum Dis 75(3):560–565. https://doi.org/10.1136/annrheumdis-2014-206411 CrossRefPubMed

Solomon, D. H., Karlson, E. W., Rimm, E. B., Cannuscio, C. C., Mandl, L. A., Manson, J. A. E., … Curhan, G. C. (2003). Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 107(9):1303–1307. https://doi.org/10.1161/01.CIR.0000054612.26458.B2

Solomon, D. H., Greenberg, J., Curtis, J. R., Liu, M., Farkouh, M. E., Tsao, P., … Etzel, C. J. (2015). Derivation and internal validation of an expanded cardiovascular risk prediction score for rheumatoid arthritis: a consortium of rheumatology researchers of North America registry study. Arthritis Rheumatol 67(8):1995–2003. https://doi.org/10.1002/art.39195

Del Rincón, I., Polak, J. F., O’Leary, D. H., Battafarano, D. F., Erikson, J. M., Restrepo, J. F., … Escalante, A. (2015). Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis. Ann Rheum Dis 74(6):1118–1123. https://doi.org/10.1136/annrheumdis-2013-205058

Arts, E. E. A., Popa, C., Den Broeder, A. A., Semb, A. G., Toms, T., Kitas, G. D., … Fransen, J. (2015). Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis 74(4):668–674. https://doi.org/10.1136/annrheumdis-2013-204024

Dessein, P. H., Corrales, A., Lopez-Mejias, R., Solomon, A., Woodiwiss, A. J., Llorca, J., … Gonzalez-Gay, M. A. (2016). The Framingham score and the systematic coronary risk evaluation at low cutoff values are useful surrogate markers of high-risk subclinical atherosclerosis in patients with rheumatoid arthritis. J Rheumatol 43(3):486–494. https://doi.org/10.3899/jrheum.150510

Ross R (1999) Atherosclerosis: an inflammatory disease. N Engl J Med 340(2):115–126CrossRefPubMed

Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Garcia-Colunga JI, Arvizu-Rivera RI, Martinez-Moreno A, Villarreal-Perez JZ, Elizondo-Riojas G, Garza Elizondo MA (2016) Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis. Clin Rheumatol 35(11):2823–2827. https://doi.org/10.1007/s10067-016-3312-z CrossRefPubMed

10.

van Breukelen–van der Stoep, D. F., van Zeben, D., Klop, B., van de Geijn, G.-J. M., Janssen, H. J. W., Hazes, M. J. M. W., … Castro Cabezas, M. (2015). Association of cardiovascular risk factors with carotid intima media thickness in patients with rheumatoid arthritis with low disease activity compared to controls: a cross-sectional study. PLoS One 10(10):e0140844. https://doi.org/10.1371/journal.pone.0140844

11.

Kullo IJ, Malik AR (2007) Arterial ultrasonography and tonometry as adjuncts to cardiovascular risk stratification. J Am Coll Cardiol 49(13):1413–1426. https://doi.org/10.1016/j.jacc.2006.11.039 CrossRefPubMed

12.

Lee KW, Park YJ, Rho Y, Kim D, Kim Y (2011) Measurement of carotid artery stenosis: correlation analysis between B-mode ultrasonography and contrast arteriography. 348–354. https://doi.org/10.4174/jkss.2011.80.5.348

13.

Stein, J. H., Korcarz, C. E., Hurst, R. T., Lonn, E., Kendall, C. B., Mohler, E. R., … Post, W. S. (2008). Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 21(2):93–111. https://doi.org/10.1016/j.echo.2007.11.011

14.

Naqvi TZ, Lee MS (2014) Carotid intima-media thickness and plaque in cardiovascular risk assessment. J Am Coll Cardiol Img 7(10):1025–1038. https://doi.org/10.1016/j.jcmg.2013.11.014 CrossRef

15.

Peters SAE, Den Ruijter HM, Grobbee DE, Bots ML (2013) Results from a carotid intima-media thickness trial as a decision tool for launching a large-scale morbidity and mortality trial. Circ Cardiovasc Imaging 6(1):20–25. https://doi.org/10.1161/CIRCIMAGING.112.978114 CrossRefPubMed

16.

Mohan, A., Sada, S., Kumar, B. S., Sarma, K. V. S., Devi, B. V., Rao, P. V. L. N. S., … Katyarmal, D. T. (2014). Subclinical atherosclerosis in patients with rheumatoid arthritis by utilizing carotid intima-media thickness as a surrogate marker. Indian J Med Res 140(3):379–86. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25366205%5Cn http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4248384

17.

Purcarea A, Sovaila S, Udrea G, Rezus E, Gheorghe A, Tiu C, Stoica V (2014) Utility of different cardiovascular disease prediction models in rheumatoid arthritis. J Med Life 7(4):588–594PubMedPubMedCentral

18.

Sillesen H, Muntendam P, Adourian A, Entrekin R, Garcia M, Falk E, Fuster V (2012) Carotid plaque burden as a measure of subclinical atherosclerosis: comparison with other tests for subclinical arterial disease in the high risk plaque bioimage study. J Am Coll Cardiol Img 5(7):681–689. https://doi.org/10.1016/j.jcmg.2012.03.013 CrossRef

19.

Goff, D. C., Lloyd-Jones, D. M., Bennett, G., Coady, S., D’Agostino, R. B., Gibbons, R., … Wilson, P. W. F. (2014). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American college of cardiology/American heart association task force on practice guidelines. Circulation 129(25 SUPPL. 1). https://doi.org/10.1161/01.cir.0000437741.48606.98

20.

González-gay MA, González-juanatey C (2014) Inflammation and lipid profile in rheumatoid arthritis: bridging an apparent paradox. Ann Rheum Dis 73(7):1281–1284CrossRefPubMed

21.

D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham heart study. Circulation 117(6):743–753. https://doi.org/10.1161/CIRCULATIONAHA.107.699579 CrossRefPubMed

22.

Mateo, I., Morillas, P., Quiles, J., Castillo, J., Andrade, H., Roldán, J., … Bertomeu-Martínez, V. (2011). What measure of carotid wall thickening is the best atherosclerotic loading score in the hypertensive patient: maximum or mean value? Revista Española de Cardiología (English Edition), 64(5):417–420. https://doi.org/10.1016/j.rec.2010.06.012

23.

Plantinga Y, Dogan S, Grobbee DE, Bots ML (2009) Carotid intima-media thickness measurement in cardiovascular screening programmes. Eur J Cardiovasc Prev Rehabil 16(6):639–644. https://doi.org/10.1097/HJR.0b013e3283312ece CrossRefPubMed

24.

Kavanaugh A, Wells AF (2014) Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis. Rheumatology (Oxford, England) 53(10):1742–1751. https://doi.org/10.1093/rheumatology/keu135

25.

Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Södergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DPM, Nurmohamed MT (2016) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76(1):17–28. https://doi.org/10.1136/annrheumdis-2016-209775

26.

Artom N, Montecucco F, Dallegri F, Pende A (2014) Carotid atherosclerotic plaque stenosis: the stabilizing role of statins. Eur J Clin Investig 44(11):1122–1134. https://doi.org/10.1111/eci.12340 CrossRef

27.

Crowson CS, Gabriel SE, Semb AG, et al (2017) Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries. 1–9. https://doi.org/10.1093/rheumatology/kex038

28.

Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Södergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DPM, Nurmohamed MT (2017) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76(1):17–28. https://doi.org/10.1136/annrheumdis-2016-209775 CrossRefPubMed

29.

Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Serna-Peña G, Arvizu-Rivera RI, Martinez-Moreno A, Wah-Suarez M, Garza Elizondo MA (2017) Assessment of six cardiovascular risk calculators in Mexican mestizo patients with rheumatoid arthritis according to the EULAR 2015/2016 recommendations for cardiovascular risk management. Clin Rheumatol 36(6):1387–1393. https://doi.org/10.1007/s10067-017-3551-7 CrossRefPubMed

30.

Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, Brindle P (2008) Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. Bmj 336(7659):1475–1482. https://doi.org/10.1136/bmj.39609.449676.25 CrossRefPubMedPubMedCentral

31.

Alcocer, L. A., Lozada, O., Fanghänel, G., Sánchez-reyes, L., & Campos-franco, E. (2011) Estratificacion del riesgo cardiovascular global. Comparacion de los metodos Framigham y SCORE en poblacion mexicana del estudio PRIT. Cirugia y Cirujanos (79):168–174

32.

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al (2016) 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 37(29):2315–2381. https://doi.org/10.1093/eurheartj/ehw106 CrossRefPubMedPubMedCentral

Medicine Matters Rheumatology

Abstract