SCORE and REGICOR function charts underestimate the cardiovascular risk in Spanish patients with rheumatoid arthritis
1 Rheumatology Division, Hospital Universitari de Bellvitge-IDIBELL, L'Hopitalet, Barcelona, Spain
2 Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IFIMAV, Avenida de Valdecilla, s/n, E-39008, Santander 39008, Spain
3 Cardiology Division of, Hospital Lucus Augusti, Lugo, Spain
4 Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, Spain
5 CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain
Arthritis Research & Therapy 2013, 15:R91 doi:10.1186/ar4271Published: 21 August 2013
Our objective was to determine which one of the two function charts available in Spain to calculate cardiovascular (CV) risk, Systematic COronary Risk Evaluation (SCORE) or Framingham-REgistre GIroní del COR (REGICOR), should be used in patients with rheumatoid arthritis (RA).
A series of RA patients seen over a one-year period without history of CV events were assessed. SCORE, REGICOR, modified (m)SCORE and mREGICOR according to the European League Against Rheumatism (EULAR) recommendations were applied. Carotid ultrasonography (US) was performed. Carotid intima-media thickness (cIMT) > 0.90 mm and/or carotid plaques were used as the gold standard test for severe subclinical atherosclerosis and high CV risk (US+). The area under the receiver operating curves (AUC) for the predicted risk for mSCORE and mREGICOR were calculated according to the presence of severe carotid US findings (US+).
We included 370 patients (80% women; mean age 58.9 ± 13.7 years); 36% had disease duration of 10 years or more; rheumatoid factor (RF) and/or anticyclic citrullinated peptide (anti-CCP) were positive in 68%; and 17% had extra-articular manifestations. The EULAR multiplier factor was used in 122 (33%) of the patients. The mSCORE was 2.16 ± 2.49% and the mREGICOR 4.36 ± 3.46%. Regarding US results, 196 (53%) patients were US+. The AUC mSCORE was 0.798 (CI 95%: 0.752 to 0.844) and AUC mREGICOR 0.741 (95% CI; 0.691 to 0.792). However, mSCORE and mREGICOR failed to identify 88% and 91% of US+ patients. More than 50% of patients with mSCORE ≥1% or mREGICOR >1% were US+.
Neither of these two function charts was useful in estimating CV risk in Spanish RA patients.