New data published in the journal Arthritis and Rheumatology suggests that the cardiovascular risk (CV) prediction models recommended for use in the general population fail to identify over half of patients with rheumatoid arthritis (RA) who are at high cardiovascular risk. The investigators studied 98 patients with RA and calculated CV risk via either the Framingham Risk Score (FRS), the Reynolds Risk Score (RRS) or the 2013 ACC/AHA risk calculator and compared those in the high risk categories to CV risk based on coronary artery calcium (CAC) scoring. The researchers used an Agatston score of >300 or >75th percentile for age, sex, and ethnicity as the threshold for a positive CAC score and high CV risk as recommended in the 2013 ACC/AHA guidelines. Patients with high CAC scores had higher risk scores on each of the three scoring tools (FRS, RRS, and ACC/AHA) but the percentage of patients who were assigned correctly to the high risk category was only 32% by FRS, 32% by RRS, and 41% by ACC/AHA risk calculator. Although the ACC/AHA risk calculator did a better job than the FRS or RRS, of the 34 patients with high CAC scores, the ACC/AHA calculator only identified 14 of them. Clearly, we need better ways of identifying CV risk in patients with RA than the tools currently recommended for the general population.
Reference: Kawai V, et al. The ability of the 2013 ACC/AHA cardiovascular risk score to identify rheumatoid arthritis patients with high coronary artery calcium scores. Arthritis Rheumatol 2014; doi: 10.1002/art.38944.