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Comparison of Risk Calculators for CV Disease in RA
J Rheumatol; 2019 Feb; Wahlin, Innala, et al
The Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) underestimated the risk of a cardiovascular (CV) event in a recent cohort study of patients, especially when risk estimations were based on patient or physician reports of hypertension (HTN) and hyperlipidemia instead of assessment of blood pressure (BP) and blood lipids. Researchers found that the performance of ERS-RA was no better than that of the American College of Cardiology/American Heart Association algorithm when adjusted according to the recommendations by the European League Against Rheumatism (ACC/AHA × 1.5) and neither performed well in high-inflammatory patients. In a cohort of patients with new-onset RA (n=665), the risk of CV disease was estimated by the ERS-RA and the ACC/AHA. They found:
- All variants of risk calculators underestimated the CV risk.
- Discrimination was good for all risk calculators studied.
- Performance of all risk calculators was poorer in patients with a high grade of inflammation, whereas ACC/AHA × 1.5 performed best in the high-inflammatory patients.
- In those patients with an estimated risk of 5–15%, no risk calculator performed well.
Wahlin B, Innala L, Magnusson S, et al. Performance of the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis is not superior to the ACC/AHA Risk Calculator. J Rheumatol. 2019;46(2):130-137. doi:10.3899/jrheum.171008.
This study found that the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) did not perform better than similar calculators designed for the general population, underestimating risks in patients with more inflammation, but also unable to predict which patients with low (5%-15%) probability of a cardiovascular event would experience such an event. An inception cohort of 662 patients newly-diagnosed with RA (69% female, average age 58.3 years) was studied. During 8.5 years of follow-up, 8.3% of females and 16.9% of male patients had a documented a cardiovascular event. Furthermore, assessment of actual blood pressure and lipid values improved risk estimation accuracy, as compared with patient or physician reports of hypertension of hyperlipidemia.—Harold E. Paulus, M.D.; Emeritus Professor; University of California, Los Angeles; Division of Rheumatology.