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Open Access Highly Accessed Research article

Utility of the Framingham risk score to predict the presence of coronary atherosclerosis in patients with rheumatoid arthritis

Cecilia P Chung1, Annette Oeser1, Ingrid Avalos1, Tebeb Gebretsadik2, Ayumi Shintani2, Paolo Raggi3, Tuulikki Sokka14, Theodore Pincus1 and C Michael Stein15*

Author Affiliations

1 Department of Medicine, Vanderbilt University School of Medicine, 1161 21st Ave., Nashville, TN 37232, USA

2 Department of Biostatistics, Vanderbilt University School of Medicine, S-2323 Medical Center North, Nashville, TN 37232, USA

3 Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1365 Clifton Road NE, AT-504, Atlanta, GA 30322

4 Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland

5 Department of Pharmacology, Vanderbilt University School of Medicine, 542 RRB, Nashville, TN 37232, USA

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Arthritis Research & Therapy 2006, 8:R186  doi:10.1186/ar2098

Published: 14 December 2006

Abstract

The prevalence of ischemic heart disease and atherosclerosis is increased in patients with rheumatoid arthritis (RA). In the general population, but not in patients with systemic lupus erythematosus, the Framingham risk score identifies patients at increased cardiovascular risk and helps determine the need for preventive interventions. We examined the hypothesis that the Framingham score is increased and associated with coronary-artery atherosclerosis in patients with RA. The Framingham score and the 10-year cardiovascular risk were compared among 155 patients with RA (89 with early disease, 66 with long-standing disease) and 85 control subjects. The presence of coronary-artery calcification was determined by electron-beam computed tomography. The Framingham score was compared in patients with RA and control subjects, and the association between the risk score and coronary-artery calcification was examined in patients. Patients with long-standing RA had a higher Framingham score (14 [11 to 18]) (median [interquartile range]) compared to patients with early RA (11 [8 to 14]) or control subjects (12 [7 to 14], P < 0.001). This remained significant after adjustment for age and gender (P = 0.015). Seventy-six patients with RA had coronary calcification; their Framingham risk score was higher (14 [12 to 17]) than that of 79 patients without calcification (10 [5 to 14]) (P < 0.001). Furthermore, a higher Framingham score was associated with a higher calcium score (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.12 to 1.29, P < 0.001), and the association remained significant after adjustment for age and gender (OR = 1.15, 95% CI 1.02 to 1.29, P = 0.03). In conclusion, a higher Framingham risk score is independently associated with the presence of coronary calcification in patients with RA.