Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Rheumatology, Maartenskliniek, Nijmegen, The Netherlands.
Ann Rheum Dis. 2015 Apr;74(4):668-74. doi: 10.1136/annrheumdis-2013-204024. Epub 2014 Jan 3.
This study was undertaken to assess the predictive ability of 4 established cardiovascular (CV) risk models for the 10-year risk of fatal and non-fatal CV diseases in European patients with rheumatoid arthritis.
Prospectively collected data from the Nijmegen early rheumatoid arthritis (RA) inception cohort was used. Discriminatory ability for CV risk prediction was estimated by the area under the receiver operating characteristic curve. Calibration was assessed by comparing the observed versus expected number of events using Hosmer-Lemeshov tests and calibration plots. Sensitivity and specificity were calculated for the cut-off values of 10% and 20% predicted risk.
Areas under the receiver operating characteristic curve were 0.78-0.80, indicating moderate to good discrimination between patients with and without a CV event. The CV risk models Systematic Coronary Risk Evaluation (SCORE), Framingham risk score (FRS) and Reynolds risk score (RRS) primarily underestimated CV risk at low and middle observed risk levels, and mostly overestimated CV risk at higher observed risk levels. The QRisk II primarily overestimated observed CV risk. For the 10% and 20% cut-off values used as indicators for CV preventive treatment, sensitivity ranged from 68-87% and 40-65%, respectively and specificity ranged from 55-76% and 77-88%, respectively. Depending on the model, up to 32% of observed CV events occurred in patients with RA who were classified as low risk (<10%) for CV disease.
Established risk models generally underestimate (Systematic Coronary Risk Evaluation score, Framingham Risk Score, Reynolds risk score) or overestimate (QRisk II) CV risk in patients with RA.
本研究旨在评估 4 种已建立的心血管（CV）风险模型在欧洲类风湿关节炎患者中预测致命和非致命 CV 疾病 10 年风险的能力。
使用前瞻性收集的尼美根早期类风湿关节炎（RA）发病队列数据。通过接受者操作特征曲线下面积评估 CV 风险预测的判别能力。通过 Hosmer-Lemeshow 检验和校准图比较观察到的与预期事件数量来评估校准。计算 10%和 20%预测风险的截断值的敏感性和特异性。
接受者操作特征曲线下面积为 0.78-0.80，表明患者有无 CV 事件之间存在中度至良好的区分能力。CV 风险模型系统冠状动脉风险评估（SCORE）、弗雷明汉风险评分（FRS）和雷诺兹风险评分（RRS）主要低估了低和中观察风险水平的 CV 风险，并且主要高估了高观察风险水平的 CV 风险。QRisk II 主要高估了观察到的 CV 风险。对于用作 CV 预防治疗指标的 10%和 20%截断值，敏感性分别为 68-87%和 40-65%，特异性分别为 55-76%和 77-88%。根据模型的不同，高达 32%的观察到的 CV 事件发生在被归类为 CV 疾病低风险（<10%）的 RA 患者中。
在 RA 患者中，已建立的风险模型通常低估（系统冠状动脉风险评估评分、弗雷明汉风险评分、雷诺兹风险评分）或高估（QRisk II）CV 风险。
