Cardiovascular risk in patients with rheumatoid arthritis: traditional scales versus carotid ultrasound
DOI:
https://doi.org/10.24265/horizmed.2025.v25n2.08Keywords:
Heart Disease Risk Factors, Arthritis, Rheumatoid, Weights and Measures , Ultrasonography, Carotid ArteriesAbstract
Objective: To compare the effectiveness of stratifying high cardiovascular disease (CVD) risk in
patients diagnosed with rheumatoid arthritis (RA) using the Framingham Risk Score (FRS), modified
Systematic Coronary Risk Evaluation (mSCORE), 2013 American College of Cardiology/American
Heart Association (2013 ACC/AHA) guidelines and QResearch Risk Estimator version 3 (QRISK3),
with carotid ultrasound (CUS) serving as the gold standard for detecting subclinical atherosclerosis.
Materials and methods: A comparative, observational and cross-sectional diagnostic study was conducted in patients aged 40 to 75 years, of both sexes, with RA and without CVD, at a tertiary
care hospital in Puebla, Mexico. Patients on treatment with one or more disease-modifying antirheumatic drugs (DMARDs) for at least three months were included. Patients with chronic diseases and those who did not undergo a CUS were excluded. CVD risk was assessed using the aforementioned risk scales—with results adjusted by a factor of 1.5 (as recommended by the 2015/2016 European League Against Rheumatism guidelines)—and
CUS to detect subclinical atherosclerosis. Results: A total of 70 out of 110 patients with high CVD risk were enrolled in the study: six (8.6 %), nine (12.9 %), three (4.3 %) and four (5.7 %) were diagnosed using FRS, 2013 ACC/AHA guidelines, QRISK3 and mSCORE, respectively. CUS detected subclinical atherosclerosis in 25 patients (35.71 %), of whom seven were classified as high CVD risk according to ACC/AHA guidelines (28 %, p = 0.006). The discriminatory power of the scales was found to be adequate
(p < 0.05), with QRISK3 demonstrating the highest effectiveness (0.737, 95 % CI: 0.609-0.866); however, no significant differences were observed between the scales. Conclusions: The estimation of CVD risk in patients with RA remains suboptimal. The use of non-invasive imaging techniques provides valuable assistance in stratifying CVD risk. Although the scales demonstrated adequate discriminatory power, they were not equivalent and their correlation with subclinical atherosclerosis was low.
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