Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 May 1;56(5):777-786.
doi: 10.1093/rheumatology/kew440.

Comparison of cardiovascular risk algorithms in patients with vs without rheumatoid arthritis and the role of C-reactive protein in predicting cardiovascular outcomes in rheumatoid arthritis

Evo Alemao  1 , Hélène Cawston  2 , François Bourhis  2 , Maiwenn Al  3   4 , Maureen Rutten-van Molken  3   4 , Katherine P Liao  5 , Daniel H Solomon  5
Affiliations
Comparative Study

Comparison of cardiovascular risk algorithms in patients with vs without rheumatoid arthritis and the role of C-reactive protein in predicting cardiovascular outcomes in rheumatoid arthritis

Evo Alemao et al. Rheumatology (Oxford). .

Abstract

Objectives: The aims were to compare the performance of cardiovascular risk calculators, Framingham Risk Score (FRS) and QRISK2, in RA and matched non-RA patients and to evaluate whether their performance could be enhanced by the addition of CRP.

Methods: We conducted a retrospective analysis, using a clinical practice data set linked to Hospital Episode Statistics (HES) data from the UK. Patients presenting with at least one RA diagnosis code and no prior cardiovascular events were matched to non-RA patients using disease risk scores. The overall performance of the FRS and QRISK2 was compared between cohorts, and assessed with and without CRP in the RA cohort using C-Index, Akaike Information Criterion (AIC) and the net reclassification index (NRI).

Results: Four thousand seven hundred and eighty RA patients met the inclusion criteria and were followed for a mean of 3.8 years. The C-Index for the FRS in the non-RA and RA cohort was 0.783 and 0.754 (P < 0.001) and that of the QRISK2 was 0.770 and 0.744 (P < 0.001), respectively. Log[CRP] was positively associated with cardiovascular events, but improvements in the FRS and QRISK2 C-Indices as a result of inclusion of CRP were small, from 0.764 to 0.767 (P = 0.026) for FRS and from 0.764 to 0.765 (P = 0.250) for QRISK2. The NRI was 3.2% (95% CI: -2.8, 5.7%) for FRS and -2.0% (95% CI: -5.8, 4.5%) for QRISK2.

Conclusion: The C-Index for the FRS and QRISK2 was significantly better in the non-RA compared with RA patients. The addition of CRP in both equations was not associated with a significant improvement in reclassification based on NRI.

Keywords: C-reactive protein; Cox; cardiovascular; net reclassification index; retrospective; rheumatoid arthritis; risk algorithm; survival.

PubMed Disclaimer

Figures

F<sc>ig</sc>. 1
Fig. 1
Time to CV event in RA and non-RA patients CV: cardiovascular.
F<sc>ig</sc>. 2
Fig. 2
Time to CV event by baseline TC and CRP levels in RA patients CV: cardiovascular; TC: total cholesterol.
F<sc>ig</sc>. 3
Fig. 3
Relative Risk of CV event in RA patients CV: cardiovascular; TC: total cholesterol.
See this image and copyright information in PMC

References

    1. Aviña-Zubieta JA, Choi HK, Sadatsafavi M et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008;59:1690–7. - PubMed
    1. Kaplan MJ. Cardiovascular complications of rheumatoid arthritis: assessment, prevention, and treatment. Rheum Dis Clin North Am 2010;36:405–26. - PMC - PubMed
    1. Meune C, Touze E, Trinquart L, Allanore Y. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 2009;48:1309–13. - PubMed
    1. Meek IL, Vonkeman HE, van de Laar MA. Cardiovascular case fatality in rheumatoid arthritis is decreasing; first prospective analysis of a current low disease activity rheumatoid arthritis cohort and review of the literature. BMC Musculoskelet Disord 2014;15:142. - PMC - PubMed
    1. Goodson N, Symmons D. Rheumatoid arthritis in women: still associated with an increased mortality. Ann Rheum Dis 2002;61:955–6. - PMC - PubMed

Substances

LinkOut - more resources