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SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ul...

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Autores principales: Ferraz-Amaro, Iván, Corrales, Alfonso, Atienza-Mateo, Belén, Vegas-Revenga, Nuria, Prieto-Peña, Diana, Sánchez-Martín, Julio, Almeida, Cristina, Quevedo-Abeledo, Juan Carlos, Blanco, Ricardo, González-Gay, Miguel Á.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700102/
https://www.ncbi.nlm.nih.gov/pubmed/34943599
http://dx.doi.org/10.3390/diagnostics11122363
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author Ferraz-Amaro, Iván
Corrales, Alfonso
Atienza-Mateo, Belén
Vegas-Revenga, Nuria
Prieto-Peña, Diana
Sánchez-Martín, Julio
Almeida, Cristina
Quevedo-Abeledo, Juan Carlos
Blanco, Ricardo
González-Gay, Miguel Á.
author_facet Ferraz-Amaro, Iván
Corrales, Alfonso
Atienza-Mateo, Belén
Vegas-Revenga, Nuria
Prieto-Peña, Diana
Sánchez-Martín, Julio
Almeida, Cristina
Quevedo-Abeledo, Juan Carlos
Blanco, Ricardo
González-Gay, Miguel Á.
author_sort Ferraz-Amaro, Iván
collection PubMed
description Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ultrasound, has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who had been included in the low or moderate CVD risk categories when the SCORE risk tables were applied. The 2003 SCORE calculator was recently updated to a new prediction model: SCORE2. This new algorithm improves the identification of individuals from the general population at high risk of developing CVD in Europe. Our objective was to compare the predictive capacity between the original SCORE and the new SCORE2 to identify RA patients with subclinical atherosclerosis and, consequently, high risk of CVD. 1168 non-diabetic patients with RA and age > 40 years were recruited. Subclinical atherosclerosis was searched for by carotid ultrasound. The presence of carotid plaque and the carotid intima media wall thickness (cIMT) were evaluated. SCORE and SCORE2 were also calculated. The relationships of SCORE and SCORE2 to each other and to the presence of subclinical carotid atherosclerosis were studied. The correlation between SCORE and SCORE2 was found to be high in patients with RA (Spearman’s Rho = 0.961, p < 0.001). Both SCORE (Spearman’s Rho = 0.524) and SCORE2 (Spearman’s Rho = 0.521) were similarly correlated with cIMT (p = 0.92). Likewise, both calculators showed significant and comparable discriminations for the presence of carotid plaque: SCORE AUC 0.781 (95%CI 0.755–0.807) and SCORE2 AUC 0.774 (95%CI 0.748–0.801). Using SCORE, 80% and 20% of the patients were in the low or moderate and high or very high CVD risk categories, respectively. However, when the same categories were evaluated using SCORE2, the percentages were different (58% and 42%, respectively). Consequently, the number of RA patients included in the high or very high CVD risk categories was significantly higher with SCORE2 compared to the original SCORE. (p < 0.001). In conclusion, although predictive capacity for the presence of carotid plaque is equivalent between SCORE and SCORE2, SCORE2 identifies a significantly higher proportion of patients with RA who are at high or very high risk of CVD.
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spelling pubmed-87001022021-12-24 SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis Ferraz-Amaro, Iván Corrales, Alfonso Atienza-Mateo, Belén Vegas-Revenga, Nuria Prieto-Peña, Diana Sánchez-Martín, Julio Almeida, Cristina Quevedo-Abeledo, Juan Carlos Blanco, Ricardo González-Gay, Miguel Á. Diagnostics (Basel) Article Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ultrasound, has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who had been included in the low or moderate CVD risk categories when the SCORE risk tables were applied. The 2003 SCORE calculator was recently updated to a new prediction model: SCORE2. This new algorithm improves the identification of individuals from the general population at high risk of developing CVD in Europe. Our objective was to compare the predictive capacity between the original SCORE and the new SCORE2 to identify RA patients with subclinical atherosclerosis and, consequently, high risk of CVD. 1168 non-diabetic patients with RA and age > 40 years were recruited. Subclinical atherosclerosis was searched for by carotid ultrasound. The presence of carotid plaque and the carotid intima media wall thickness (cIMT) were evaluated. SCORE and SCORE2 were also calculated. The relationships of SCORE and SCORE2 to each other and to the presence of subclinical carotid atherosclerosis were studied. The correlation between SCORE and SCORE2 was found to be high in patients with RA (Spearman’s Rho = 0.961, p < 0.001). Both SCORE (Spearman’s Rho = 0.524) and SCORE2 (Spearman’s Rho = 0.521) were similarly correlated with cIMT (p = 0.92). Likewise, both calculators showed significant and comparable discriminations for the presence of carotid plaque: SCORE AUC 0.781 (95%CI 0.755–0.807) and SCORE2 AUC 0.774 (95%CI 0.748–0.801). Using SCORE, 80% and 20% of the patients were in the low or moderate and high or very high CVD risk categories, respectively. However, when the same categories were evaluated using SCORE2, the percentages were different (58% and 42%, respectively). Consequently, the number of RA patients included in the high or very high CVD risk categories was significantly higher with SCORE2 compared to the original SCORE. (p < 0.001). In conclusion, although predictive capacity for the presence of carotid plaque is equivalent between SCORE and SCORE2, SCORE2 identifies a significantly higher proportion of patients with RA who are at high or very high risk of CVD. MDPI 2021-12-15 /pmc/articles/PMC8700102/ /pubmed/34943599 http://dx.doi.org/10.3390/diagnostics11122363 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ferraz-Amaro, Iván
Corrales, Alfonso
Atienza-Mateo, Belén
Vegas-Revenga, Nuria
Prieto-Peña, Diana
Sánchez-Martín, Julio
Almeida, Cristina
Quevedo-Abeledo, Juan Carlos
Blanco, Ricardo
González-Gay, Miguel Á.
SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis
title SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis
title_full SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis
title_fullStr SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis
title_full_unstemmed SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis
title_short SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis
title_sort score2 assessment in the calculation of cardiovascular risk in patients with rheumatoid arthritis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700102/
https://www.ncbi.nlm.nih.gov/pubmed/34943599
http://dx.doi.org/10.3390/diagnostics11122363
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