CVD Risk in RA Differs from CVD Risk in General Population

June 14, 2016

EULAR 2016: Cardiovascular disease risk in rheumatoid arthritis is quite different from risk factors in the general population. Risk calculators should be different too, experts say.

The risk factors for cardiovascular disease in rheumatoid arthritis patients are quite different than risk factors associated with the general population, researchers reported at the European League Against Rheumatism Annual Congress (EULAR 2016) in London on June 10.

What would be considered “non-traditional risk factors” in the general population is considered the norm in rheumatoid arthritis. Inflammatory markers, seropositivity, physical disability, destructive changes on joint radiographs, extra-articular manifestations and corticosteroid use, have been shown to have significant associations with increased cardiovascular risk. Other cardiovascular disease risk factors in rheumatoid arthritis include medications, such as nonsteroidal anti-inflammatory drugs.2

In a review published in the June 2016 issue of Therapeutic Advances in Musculoskeletal Disease, researchers wrote that, the “cumulative inflammatory burden and anti-rheumatic medication-related cardiotoxicity seem to be important contributors.”  [[{"type":"media","view_mode":"media_crop","fid":"49412","attributes":{"alt":"©SebastianKaulitzki/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_8886699352259","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5961","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©SebastianKaulitzki/Shutterstock.com","typeof":"foaf:Image"}}]]

Risk scores developed for the general population are unlikely to accurately estimate cardiovascular risk in rheumatoid arthritis, researchers say.2

In the study presented at EULAR 2016, Cynthia S. Crowson, M.S., of Mayo Clinic, and colleagues assessed the risk calculators recommended for rheumatoid arthritis patients. These included the European League Against Rheumatism (EULAR) 1.5 multiplier, the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) and QRISK2.

The study included 1,796 rheumatoid arthritis patients without prior cardiovascular disease (mean age: 54, 74 percent female) and of these, 100 developed a cardiovascular disease event within seven years (mean follow-up years).

Researchers wrote that cardiovascular disease risk by ERS-RA (mean: 8.8%, SD:9.8%) was comparable to FRS-ATP (mean:9.1%, SD:8.3%) and Reynolds (mean:9.2%,SD:12.2%), but lower than ACC/AHA (mean: 9.8%,SD:12.1%) and QRISK2 (mean:15.5%,SD:13.9%) estimates.

“The QRISK2, EULAR multiplier and ERS-RA algorithms did not predict CVD risk more accurately in patients with RA than CVD risk calculators developed for the general population,” researchers wrote in their abstract presentation.

The European League Against Rheumatism (EULAR) published recommendations suggesting the adoption of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. The guidance requires the coordination of general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists.

“Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients,” the authors of the review wrote.

 

 

 

References:

1. C. S. Crowson, S. E. Gabriel. “Rheumatoid Arthritis-Specific Cardiovascular Risk Calculators are Not Superior to Risk Calculators Established for the General Population: A Validation Analysis in a Cohort of RA Patients From 7 Countries.” EULAR 2016. Abstract number:  OP0257

2. Gabriel SE, Crowson CS. “Risk factors for cardiovascular disease in rheumatoid arthritis.” Curr Opin Rheumatol. 2012 Mar;24(2):171-6. doi: 10.1097/BOR.0b013e32834ff2fd.

3. Zegkos T, Kitas G, Dimitroulas T. “Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps.”  Ther Adv Musculoskelet Dis. 2016 Jun;8(3):86-101. doi: 10.1177/1759720X16643340. Epub 2016 Apr 30.