Crowson Cynthia S, Gabriel Sherine E, Semb Anne Grete, van Riel Piet L C M, Karpouzas George, Dessein Patrick H, Hitchon Carol, Pascual-Ramos Virginia, Kitas George D
Department of Health Sciences Research and Department of Medicine, Mayo Clinic, Rochester, MN.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Rheumatology (Oxford). 2017 Jul 1;56(7):1102-1110. doi: 10.1093/rheumatology/kex038.
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.
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 c-statistics and net reclassification index.
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).
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.
为普通人群开发的心血管疾病（CVD）风险计算器不能准确预测类风湿关节炎（RA）患者的CVD事件。我们试图对推荐用于RA患者的风险计算器进行外部验证，包括欧洲抗风湿病联盟（EULAR）1.5倍乘数法、RA扩展心血管风险预测评分（ERS-RA）和QRISK2。
合并了来自英国、挪威、荷兰、美国、南非、加拿大和墨西哥的7个RA队列。使用标准化定义收集关于基线CVD危险因素、RA特征和CVD结局（包括心肌梗死、缺血性卒中和心血管死亡）的数据。使用c统计量和净重新分类指数，将QRISK2、EULAR乘数法和ERS-RA的性能与其他风险计算器[美国心脏病学会/美国心脏协会（ACC/AHA）、弗雷明汉成人治疗组III弗雷明汉风险评分-成人治疗组（FRS-ATP）和雷诺兹风险评分]进行比较。
在1796例无既往CVD的RA患者中[平均（标准差）年龄：54.0（14.0）岁，74%为女性]，在平均6.9年（12430人年）的随访期间，100例发生了CVD事件。ERS-RA估计的CVD风险[平均（标准差）8.8%（9.8%）]与FRS-ATP[平均（标准差）9.1%（8.3%）]和雷诺兹评分[平均（标准差）9.2%（12.2%）]相当，但低于ACC/AHA[平均（标准差）9.8%（12.1%）]。QRISK2显著高估了风险[平均（标准差）15.5%（13.9%）]。与ACC/AHA（所有的c统计量均为0.72）或FRS-ATP（c统计量=0.75）相比，应用于ACC/AHA的ERS-RA、QRISK2或EULAR乘数法的辨别力并未提高。ERS-RA的净重新分类指数较低（与ACC/AHA相比为-0.8%，与FRS-ATP相比为2.3%）。
与为普通人群开发的CVD风险计算器相比，QRISK2、EULAR乘数法和ERS-RA算法在预测RA患者的CVD风险方面并不更准确。
