TY - JOUR
T1 - Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores
T2 - A validation analysis of patients from seven countries
AU - Crowson, Cynthia S.
AU - Gabriel, Sherine E.
AU - Semb, Anne Grete
AU - van Riel, Piet L.C.M.
AU - Karpouzas, George
AU - Dessein, Patrick H.
AU - Hitchon, Carol
AU - Pascual-Ramos, Virginia
AU - Kitas, George D.
AU - Douglas, Karen
AU - Sandoo, Aamer
AU - Rollefstad, Silvia
AU - Ikdahl, Eirik
AU - Kvien, Tore K.
AU - Arts, Elke
AU - Fransen, Jaap
AU - Tsang, Linda
AU - El-Gabalawy, Hani
AU - Yáñez, Irazú Contreras
AU - Matteson, Eric L.
AU - Rantapää-Dahlqvist, Solbritt
AU - Sfikakis, Petros P.
AU - Zampeli, Evi
AU - Gonzalez-Gay, Miguel
AU - Corrales, Alfonso
AU - van de Laar, Mart
AU - Vonkeman, Harald
AU - Meek, Inger
AU - Husni, Elaine
AU - Overman, Robert
AU - Colunga, Iris
AU - Galarza, Dionicio
AU - On behalf of A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis
N1 - Funding Information:
Karen Douglas and Aamer Sandoo, Dudley Group NHS Foundation Trust, West Midlands, UK; Silvia Rollefstad, Eirik Ikdahl and Tore K. Kvien, Diakonhjemmet hospital, Oslo, Norway; Elke Arts and Jaap Fransen, Radboud University, Nijmegen, Netherlands; Linda Tsang, Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Heath Sciences, University of Witwatersrand, Johannesburg, South Africa; Hani El-Gabalawy, University of Manitoba, Winnipeg, Manitoba, Canada; Irazu Contreras Ya?ez, Instituto Nacional de Ciencias M? dicas y Nutrici?n Salvador Zubir, Mexico City, M? xico; Eric L Matteson, Mayo Clinic, Rochester, MN, USA; Solbritt Rantap??-Dahlqvist, Solveig Wa? llberg-Jonsson and Lena Innala, University Hospital, Umea?, Sweden; Petros P. Sfikakis and Evi Zampeli, University of Athens, Athens, Greece; Miguel Gonzalez-Gay and Alfonso Corrales, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain; Mart van de Laar, Harald Vonkeman and Inger Meek, Hospital Medisch Spectrum Twente, Enschede, Netherlands; Elaine Husni and Robert Overman, Cleveland Clinic, Cleveland, Ohio, USA; Iris Colunga and Dionicio Galarza, Hospital Universitario 'Dr Jos? E. Gonzalez', Monterrey, M? xico. This work was supported by a collaborative agreement for independent research from Eli Lilly and a grant from the National Institutes of Health, NIAMS (R01AR046849). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Objectives: 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.Methods: 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.Results: 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).Conclusion: 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.
AB - Objectives: 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.Methods: 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.Results: 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).Conclusion: 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.
KW - Cardiovascular disease
KW - Rheumatoid arthritis
KW - Risk assessment
KW - Risk prediction
UR - http://www.scopus.com/inward/record.url?scp=85021701759&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/kex038
DO - 10.1093/rheumatology/kex038
M3 - Article
C2 - 28339992
AN - SCOPUS:85021701759
VL - 56
SP - 1102
EP - 1110
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 7
ER -