AB0327 CARDIOVASCULAR RISK ASSESSMENT IN RHEUMATOID ARTHRITIS WITH CAROTID ULTRASONOGRAPHY AND CARDIOVASCULAR RISK SCORES: A CASE CONTROL STUDY
Background The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than individuals from the general population. This excess risk might be explained by the chronic inflammation. Objectives To assess the Cardiovascular Risk (CV) in Rheumatoid Arthritis (RA) patie...
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Published in | Annals of the rheumatic diseases Vol. 81; no. Suppl 1; pp. 1287 - 1288 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
01.06.2022
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Online Access | Get full text |
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Summary: | Background
The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than individuals from the general population. This excess risk might be explained by the chronic inflammation.
Objectives
To assess the Cardiovascular Risk (CV) in Rheumatoid Arthritis (RA) patients using the Framingham Score, SCORE (systematic coronary risk evaluation) and carotid ultrasound additionally to the traditional cardiovascular risk factors.
Methods
A single center case control study was performed. Inclusion criteria were adult RA patients (cases) and matched healthy adults in terms of age, sex, and CV risk factors (controls). Population over 75 years old, patients with established CV disease and/or stage III chronic kidney disease were excluded. Controls with other inflammatory diseases, pregnant women or any malignancy were also excluded. This study was performed from July-2019 to January-2020. The US study included presence of plaques, plaque number and measurement the intima-media thickness in both right and left carotid. Scores were multiplicated x1.5 according to EULAR recommendations.
Results
Overall, a total of 200 cases and 111 healthy controls were included in the study. Demographical and clinical variables were comparable between cases and controls and are shown in Table 1. In both groups a relationship between age, BMI and high blood pressure was detected (p<0.001). RA patients had a Disease duration of 18.93 years (11.36); 163 (81.5%) Erosions (X-Ray of hands/feet), Extra-articular symptoms 44 (22%), Prednisone use 103 (51.5%) with Median dose of Prednisone last year 2.34 (2.84). In treatment with Methotrexate 104 (52%), bDMARDs 89 (44.5%) and JAK inhibitor 26 (13%). US study revealed a higher IMT in both right and left carotid arteries with greater presence of plaques in patients than in controls (CI 95% [1.542; 3.436], p<0.001). Plaques were found in both carotid arteries in the 32% of cases and 9.91% of controls. The longer duration of RA was related to a higher presence of carotid plaques (95% [1.015; 1.056], p<0.001). US and blood test results are shown in Table 3. SCORE and Framingham correlated with the CV estimation with US (p<0.001), however, seemed to underestimate the global findings in cases (p<0.001).
Table 1.
Demographic, clinical characteristics, Ultrasound Results, SCORE and Framingham of patients and controls.
Characteristic
RA cases n=200
Healthy controls n=111
Age - years
62.05 (10.75)
58.3 (12.14)
Female sex – number (%)
163 (81.5)
73 (65.77)
BMI – value (ds)
26.38 (5.03)
26.2 (5.19)
Smoking habit
Never Smoked
107 (53.5%)
71 (63.96%)
Ex-smoker
51 (25.5%)
20 (18.02%)
Active smoker
42 (21%)
20 (18.2%)
Race – number (%)Caucasian
186 (93)
62 (93.94)
Comorbidities – number (%)
High blood pressure
83 (41.5%)
34 (30.63%)
Dyslipemia
93 (46.5%)
39 (35.14%)
Blood pressure -- mmHg
127.2(18.36)/78.67(10.21)
127.77(19.42)/78.28 (10.59)
Ultrasound findings
Right carotid cIMT
0.78 (0.15)
0.62 (0.11)
Left carotid cIMT
0.77 (0.14)
0.64 (0.12)
Plaques
101 (50.5%)
32 (28.83%)
Bilateral
64 (32%)
11 (9.91%)
Right carotid
17 (8.5%)
7 (6.31%)
Left carotid
20 (10%)
14 (12.61%)
SCORE
Very Hihg
13 (6.5%)
5 (4.5%)
High
31 (15.5%)
15 (13.51%)
Low
156 (78%)
91 (81.98%)
Framingham
High
76 (38%)
33 (29.7%)
Low
124 (62%)
78 (70.3%)
Conclusion
Cardiovascular risk calculators such as Framingham and SCORE are useful in RA risk estimation. However, those tools may underestimate the real risk, so carotid US might be valuable.
Disclosure of Interests
None declared |
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ISSN: | 0003-4967 1468-2060 |
DOI: | 10.1136/annrheumdis-2022-eular.5225 |