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Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries
- Source :
- Rheumatology, 56, 1102-1110, Rheumatology (Oxford, England), vol 56, iss 7, Rheumatology, 56, 7, pp. 1102-1110
- Publication Year :
- 2017
-
Abstract
- Item does not contain fulltext 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.
- Subjects :
- rheumatoid arthritis
Male
Internationality
Comorbidity
030204 cardiovascular system & hematology
Cardiovascular
Severity of Illness Index
Arthritis, Rheumatoid
Cohort Studies
South Africa
risk prediction
0302 clinical medicine
cardiovascular disease
Rheumatoid
Medicine
Pharmacology (medical)
Myocardial infarction
Cardiovascular Diseases/diagnosis
Netherlands
education.field_of_study
Framingham Risk Score
South Africa/epidemiology
Norway
United Kingdom/epidemiology
Incidence
risk assessment
Clinical Science
Middle Aged
Cardiovascular disease
Prognosis
United States/epidemiology
Norway/epidemiology
comorbidity
Heart Disease
Cardiovascular Diseases
Predictive value of tests
Public Health and Health Services
Arthritis, Rheumatoid/diagnosis
Cohort studies
Female
Risk assessment
Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis
Algorithms
Cohort study
Adult
medicine.medical_specialty
Canada
Clinical Sciences
Immunology
Population
Netherlands/epidemiology
Risk Assessment
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
03 medical and health sciences
Age Distribution
Rheumatology
Clinical Research
Predictive Value of Tests
Internal medicine
Severity of illness
Mexico/epidemiology
Humans
Sex Distribution
education
Mexico
Aged
030203 arthritis & rheumatology
business.industry
Arthritis
Prevention
medicine.disease
United States
United Kingdom
Arthritis & Rheumatology
Physical therapy
incidence
business
Subjects
Details
- ISSN :
- 14620324
- Database :
- OpenAIRE
- Journal :
- Rheumatology, 56, 1102-1110, Rheumatology (Oxford, England), vol 56, iss 7, Rheumatology, 56, 7, pp. 1102-1110
- Accession number :
- edsair.doi.dedup.....09672b9d58018fd856325ceab4c85f5b