Purcarea A, Sovaila S, Udrea G, Rezus E, Gheorghe A, Tiu C, Stoica V
Strasbourg Medical University, Civil Hospital Strasbourg, Internal Medicine Department, France ; "Carol Davila" University of Medicine and Pharmacy, "Cantacuzino" Hospital, Internal Medicine and Rheumatology Department, Bucharest, Romania.
Civil Hospital Strasbourg, Internal Medicine Department, France.
J Med Life. 2014 Oct-Dec;7(4):588-94.
Rheumatoid arthritis comes with a 30% higher probability for cardiovascular disease than the general population. Current guidelines advocate for early and aggressive primary prevention and treatment of risk factors in high-risk populations but this excess risk is under-addressed in RA in real life. This is mainly due to difficulties met in the correct risk evaluation. This study aims to underline the differences in results of the main cardiovascular risk screening models in the real life rheumatoid arthritis population.
In a cross-sectional study, patients addressed to a tertiary care center in Romania for an biannual follow-up of rheumatoid arthritis and the ones who were considered free of any cardiovascular disease were assessed for subclinical atherosclerosis. Clinical, biological and carotidal ultrasound evaluations were performed. A number of cardiovascular disease prediction scores were performed and differences between tests were noted in regard to subclinical atherosclerosis as defined by the existence of carotid intima media thickness over 0,9 mm or carotid plaque.
In a population of 29 Romanian rheumatoid arthritis patients free of cardiovascular disease, the performance of Framingham Risk Score, HeartSCORE, ARIC cardiovascular disease prediction score, Reynolds Risk Score, PROCAM risk score and Qrisk2 score were compared. All the scores under-diagnosed subclinical atherosclerosis. With an AUROC of 0,792, the SCORE model was the only one that could partially stratify patients in low, intermediate and high-risk categories. The use of the EULAR recommended modifier did not help to reclassify patients.
The only score that showed a statistically significant prediction capacity for subclinical atherosclerosis in a Romanian rheumatoid arthritis population was SCORE. The additional calibration or the use of imaging techniques in CVD risk prediction for the intermediate risk category might be warranted.
类风湿关节炎患者患心血管疾病的概率比普通人群高30%。当前指南提倡对高危人群进行早期积极的一级预防和危险因素治疗，但在现实生活中，类风湿关节炎患者的这种额外风险并未得到充分解决。这主要是由于在正确的风险评估中遇到困难。本研究旨在强调现实生活中类风湿关节炎人群主要心血管风险筛查模型结果的差异。
在一项横断面研究中，对前往罗马尼亚一家三级医疗中心进行类风湿关节炎半年随访的患者以及被认为无任何心血管疾病的患者进行亚临床动脉粥样硬化评估。进行了临床、生物学和颈动脉超声评估。计算了多个心血管疾病预测评分，并记录了各项检测在由颈动脉内膜中层厚度超过0.9毫米或颈动脉斑块定义的亚临床动脉粥样硬化方面的差异。
在29名无心血管疾病的罗马尼亚类风湿关节炎患者中，比较了弗明汉风险评分、HeartSCORE、ARIC心血管疾病预测评分、雷诺兹风险评分、PROCAM风险评分和Qrisk2评分的表现。所有评分均对亚临床动脉粥样硬化诊断不足。SCORE模型的曲线下面积为0.792，是唯一能将患者部分分层为低、中、高风险类别的模型。使用欧洲抗风湿病联盟推荐的修正因素无助于对患者重新分类。
在罗马尼亚类风湿关节炎人群中，唯一对亚临床动脉粥样硬化显示出具有统计学意义预测能力的评分是SCORE。对于中风险类别，在心血管疾病风险预测中可能需要额外的校准或使用成像技术。
