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Abstract: Objectives. Cardiovascular disease (CVD) risk calculators developed for the general population do not
accurately predict CVD events in patients with RA. We sought to externally validate risk calculators recommended
for use in patients with RA including the EULAR 1.5 multiplier, the Expanded Cardiovascular
Risk Prediction Score for RA (ERS-RA) and QRISK2.
Methods. Seven RA cohorts from UK, Norway, Netherlands, USA, South Africa, Canada and Mexico were
combined. Data on baseline CVD risk factors, RA characteristics and CVD outcomes (including myocardial
infarction, ischaemic stroke and cardiovascular death) were collected using standardized definitions.
Performance of QRISK2, EULAR multiplier and ERS-RA was compared with other risk calculators
[American College of Cardiology/American Heart Association (ACC/AHA), Framingham Adult Treatment
Panel III Framingham risk score-Adult Treatment Panel (FRS-ATP) and Reynolds Risk Score] using cstatistics
and net reclassification index.
Results. Among 1796 RA patients without prior CVD [mean (S.D.) age: 54.0 (14.0) years, 74% female], 100
developed CVD events during a mean follow-up of 6.9 years (12430 person-years). Estimated CVD risk by
ERS-RA [mean (S.D.) 8.8% (9.8%)] was comparable to FRS-ATP [mean (S.D.) 9.1% (8.3%)] and Reynolds
[mean (S.D.) 9.2% (12.2%)], but lower than ACC/AHA [mean (S.D.) 9.8% (12.1%)]. QRISK2 substantially
overestimated risk [mean (S.D.) 15.5% (13.9%)]. Discrimination was not improved for ERS-RA (c-statistic
= 0.69), QRISK2 or EULAR multiplier applied to ACC/AHA compared with ACC/AHA (c-statistic = 0.72
for all) or for FRS-ATP (c-statistic = 0.75). The net reclassification index for ERS-RA was low (0.8% vs
ACC/AHA and 2.3% vs FRS-ATP).
Conclusion. The QRISK2, EULAR multiplier and ERS-RA algorithms did not predict CVD risk more accurately
in patients with RA than CVD risk calculators developed for the general population.
Fuente: Rheumatology (Oxford). 2017 Jul 1;56(7):1102-1110
Editorial: Oxford University Press
Año de publicación: 2017
Nº de páginas: 9
Tipo de publicación: Artículo de Revista
CROWSON, CYNTHIA S.
GABRIEL, SHERINE E.
SEMB, ANNE GRETE
RIEL, PIET L. C. M. VAN
DESSEIN, PATRICK H.
PASCUAL RAMOS, VIRGINIA
KITAS, GEORGE D.
TRANS-ATLANTIC CARDIOVASCULAR CONSORTIUM FOR RHEUMATOID ARTHRITIS
MIGUEL ANGEL GONZALEZ-GAY MANTECON
ALFONSO FERNANDO CORRALES MARTINEZ