FRI0083 Adjustment of the threshold may improve cardiovascular risk stratification in patients with rheumatoid arthritis

Background Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) risk. Besides monitoring of the disease activity, identification of high CV risk patients is of great importance1,2. Objectives The aim of the study was to assess the abilities of 3 risk models (SCORE, QRisk 2 and 10 year ASCVD) in detecting high CV risk RA patients. Methods 56 patients with RA (ACR/EULAR 2010 without known CV disease were examined (84% females, age 58.4±14.1 (M±SD) years, BMI 26.1±5.4 kg/m2, smokers 9%, arterial hypertension (AH) 64%, dyslipidemia 57%, diabetes 7%). Median duration of RA was 7 years (IQR 2–14). Seropositive RA was diagnosed in 73% of patients. Median hsCRP was 7.8 mg/dl (IQR 2;21.4), rheumatoid factor (RF) – 61.2 IU/ml (IQR 18.5;179.2), mean DAS-28(CRP) – 3,7±1,2. All patients received disease-modifying antirheumatic drugs. SCORE, QRisk2 and 2013 ACC/AHA 10 year ASCVD risk and EULAR recommended modified versions were calculated. Patients with SCORE ≥5%, QRisk2 ≥20% and ASCVD risk ≥7.5% were classified as having high CV risk. Carotid intima-media thickness (CIMT) ≥0,9 mm and/or carotid plaques detected by ultrasonography were used as the gold standard test for high CV risk. p Results The median SCORE, QRisk2 and ASCVD were 2.2% (IQR 0.6;4.9), 10.2% (3.4;19.2) and 4.9% (1.5;12.8) respectively. The proportion of high-risk patients was as follows: 14 (25%), 13 (23%), 24 (43%) for SCORE, QRisk2 and ASCVD. Mean CIMT was 0.76±0.24 mm. US criteria for subclinical atherosclerosis (US+) were found in 27 (48%) pts. Discriminating capacities for the indexes were as follows: AUC 0.723 (CI 95% 0.626–0.821) for SCORE, AUC 0.705 (CI 95% 0.606–0.804) for QRisk2 and AUC 0.837 (CI 95% 0.757–0.917) for ASCVD. The percentages of high-risk patients in US+group were as follows: 13 (48%), 12 (44%) and 21 (78%), respectively, (p Conclusions The 2013 ACC/AHA 10 year ASCVD risk estimator is better than the SCORE and QRisk2 indices for the detection of high CV risk RA patients. Adjustment of the threshold may be a better modification of risk scales than use of the EULAR multiplier factor. References [1] Agca R, Heslinga S, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis2017;76(1):17–28. [2] Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in pa- tients with rheumatoid arthritis: a meta-analysis of obser- vational studies. Ann Rheum Dis2012;71:1524–9. Disclosure of Interest None declared