Campos Fernández Cristina, Fragío Gil Jorge Juan, González Mazarío Roxana, Martínez Calabuig Pablo, Román Ivorra José Andrés
Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
Servicio de Reumatología, Hospital General Universitario de Valencia, Spain.
Ther Adv Musculoskelet Dis. 2024 Dec 11;16:1759720X241302667. doi: 10.1177/1759720X241302667. eCollection 2024.
Rheumatoid arthritis (RA) increases the risk of premature mortality, primarily due to cardiovascular diseases (CVD). While Systematic Coronary Risk Evaluation (SCORE) and its updated version SCORE2 are used to estimate CVD risk, these tools may not adequately capture the full cardiovascular risk profile in RA patients.
This study aims to compare the effectiveness of SCORE2 versus SCORE in predicting the presence of carotid plaques or increased intima-media thickness (IMT), as detected by ultrasound, in RA patients.
This was a single-center cross-sectional study and included adult RA patients with moderate to severe disease who initiated treatment with Janus kinase inhibitors or anti-tumor necrosis factor inhibitors between September 2022 and April 2023.
Both SCORE and SCORE2 were calculated for each patient. Carotid ultrasound examinations documented the presence of plaques, and IMT was measured.
A total of 122 patients were included. The mean SCORE was 2.48%, while SCORE2 was significantly higher at 4.07% ( < 0.01). SCORE identified 12 (10%) patients as high risk, while SCORE2 identified 99 (81%). Atherosclerotic plaques were present in 34% ( = 42) of participants. Traditional cardiovascular risk factors (dyslipidemia, diabetes, hypertension, and smoking) were significantly associated with ultrasound-detected risk. In 87 cases where SCORE was underestimated, 34 patients (39%) classified as low-moderate risk by SCORE were correctly reclassified as high risk by SCORE2. However, 54 cases classified as high risk by SCORE2 had normal carotid ultrasounds. The sensitivity of SCORE for predicting plaque presence was 21%, compared to 100% for SCORE2. Combining SCORE with carotid ultrasound increased the detection of high-risk patients from 10% to 38%. However, adding carotid ultrasound to SCORE2 did not increase the detection rate beyond 81%.
Our findings highlight the superior performance of SCORE2 compared to SCORE in identifying RA patients with carotid ultrasound abnormalities, thus indicating a higher cardiovascular risk.
类风湿关节炎（RA）会增加过早死亡的风险，主要是由于心血管疾病（CVD）。虽然系统性冠状动脉风险评估（SCORE）及其更新版本SCORE2用于估计心血管疾病风险，但这些工具可能无法充分反映RA患者的全部心血管风险状况。
本研究旨在比较SCORE2与SCORE在预测RA患者经超声检测出的颈动脉斑块或内膜中层厚度（IMT）增加方面的有效性。
这是一项单中心横断面研究，纳入了2022年9月至2023年4月期间开始使用Janus激酶抑制剂或抗肿瘤坏死因子抑制剂治疗的中度至重度成年RA患者。
为每位患者计算SCORE和SCORE2。颈动脉超声检查记录斑块的存在情况，并测量IMT。
共纳入122例患者。SCORE的平均值为2.48%，而SCORE2显著更高，为4.07%（<0.01）。SCORE将12例（10%）患者确定为高风险，而SCORE2确定了99例（81%）。34%（n = 42）的参与者存在动脉粥样硬化斑块。传统心血管危险因素（血脂异常、糖尿病、高血压和吸烟）与超声检测出的风险显著相关。在SCORE被低估的87例病例中，34例（39%）被SCORE分类为低 - 中度风险的患者被SCORE2正确重新分类为高风险。然而，54例被SCORE2分类为高风险的病例颈动脉超声检查正常。SCORE预测斑块存在的敏感性为21%，而SCORE2为100%。将SCORE与颈动脉超声相结合，高风险患者的检出率从10%提高到了38%。然而，在SCORE2中加入颈动脉超声并没有使检出率超过81%。
我们的研究结果突出了SCORE2在识别有颈动脉超声异常的RA患者方面比SCORE表现更优，从而表明心血管风险更高。
