Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms

• Published in: Annals of the rheumatic diseases Vol. 75; no. 4; pp. 674 - 680
• Main Authors: Arts, E E A, Popa, C D, Den Broeder, A A, Donders, R, Sandoo, A, Toms, T, Rollefstad, S, Ikdahl, E, Semb, A G, Kitas, G D, Van Riel, P L C M, Fransen, J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2016
• Subjects: Adult; Age Factors; Aged; Algorithms; Angina pectoris; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - epidemiology; Arthritis, Rheumatoid - immunology; Biological Factors - therapeutic use; Cardiovascular Diseases - epidemiology; Cohort Studies; Diabetes Mellitus - epidemiology; Dyslipidemias - epidemiology; Female; Health risk assessment; Heart attacks; Humans; Hypertension - epidemiology; Male; Middle Aged; Netherlands - epidemiology; Peptides, Cyclic - immunology; Proportional Hazards Models; Rheumatoid arthritis; Rheumatoid Factor - immunology; Risk Assessment; Risk Factors; Severity of Illness Index; Sex Factors; Smoking - epidemiology; Netherlands; Cardiovascular Disease; Rheumatoid Arthritis; Disease Activity
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2014-206879

ObjectivesPredictive performance of cardiovascular disease (CVD) risk calculators appears suboptimal in rheumatoid arthritis (RA). A disease-specific CVD risk algorithm may improve CVD risk prediction in RA. The objectives of this study are to adapt the Systematic COronary Risk Evaluation (SCORE) algorithm with determinants of CVD risk in RA and to assess the accuracy of CVD risk prediction calculated with the adapted SCORE algorithm.MethodsData from the Nijmegen early RA inception cohort were used. The primary outcome was first CVD events. The SCORE algorithm was recalibrated by reweighing included traditional CVD risk factors and adapted by adding other potential predictors of CVD. Predictive performance of the recalibrated and adapted SCORE algorithms was assessed and the adapted SCORE was externally validated.ResultsOf the 1016 included patients with RA, 103 patients experienced a CVD event. Discriminatory ability was comparable across the original, recalibrated and adapted SCORE algorithms. The Hosmer–Lemeshow test results indicated that all three algorithms provided poor model fit (p<0.05) for the Nijmegen and external validation cohort. The adapted SCORE algorithm mainly improves CVD risk estimation in non-event cases and does not show a clear advantage in reclassifying patients with RA who develop CVD (event cases) into more appropriate risk groups.ConclusionsThis study demonstrates for the first time that adaptations of the SCORE algorithm do not provide sufficient improvement in risk prediction of future CVD in RA to serve as an appropriate alternative to the original SCORE. Risk assessment using the original SCORE algorithm may underestimate CVD risk in patients with RA.