Ab0382 comparison of cardiovascular risk scales according to time of evolution in rheumatoid arthritis patients

Background Rheumatoid arthritis (RA) is a chronic, multisystemic and multifactorial disease. RA patients are at increased risk of cardiovascular (CV) morbimortality, with atherosclerotic CV disease being the leading cause of death. The traditional risk factors cannot explain such an increase by themselves. (1) There are many algorithms for CV risk (CVR) prediction, and results obtained by these must be multiplied by 1.5 factor, since the EULAR recommendation from 2016. (2) Objectives To compare CVR by six scales: Framingham lipids and BMI, ACC/AHA ASCVD 2013, Reynolds (RRS), SCORE 2 and QRISK III, according to the time of disease evolution in RA patients. Methods Descriptive, comparative, and cross-sectional study. We enrolled RA patients between 40 and 75 years old who fulfilled ACR/EULAR 2010 classification criteria and recruited in the Rheumatology service from a tertiary care hospital. Patients were divided by time of disease evolution into quartiles. CVR results from scales were multiplied by 1.5 factor according to EULAR 2016 recommendation. Normality was assessed by Kolmogorov-Smirnov test. Variables with a non-normal distribution were described by median and interquartile range (p25-p75). Differences between groups was analyzed by Kruskal-Wallis test or Chi-squared, accordingly. Results Total of 406 RA patients were included. Demographic characteristics are shown in table 1. For longer disease evolution, CV scales showed an increased (except for RRS; p= 0.123), just like anti-citrullinated peptide antibody (p=0.001), rheumatoid factor IgG (p=0.003), IgM (p=0.00) and IgA (p=0.00). Conclusion CVR increased according to disease duration. Despite that most of the scales showed such increased, CVR varies between them, which may be attributable to the variables evaluated in each one. More studies are required to define which scale is the best to predict in RA patients. References [1]England BR, Thiele GM, Anderson DR, Mikuls TR. Increased cardiovascular risk in rheumatoid arthritis: Mechanisms and implications. BMJ (Online). 2018;361. [2]Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017 Jan;76(1):17–28. Table 1. Demographic characteristics (n= 406) Variable 1st Quartile (n= 102) 2nd Quartile (n=101) 3rd Quartile (n=102) 4th Quartile (n=101) p Duration of disease, years. median (p25-p75) 1.12 (0.93-2.00) 4.84 (3.62-5.70) 10.62 (9.03-12.80) 19.69 (15.94-24.43) Women, (n)% 94 (92) 89 (88) 98 (96) 93 (92) NS Age, years. median (p25-p75) 56 (49-62) 55 (48-62) 56 (48-60) 57 (49-62) 0.002 BMI, kg/m2. median (p25-p75) 27.2 (24.6-31.1) 28.6 (26.1-32.1) 28.1 (24.5-32.5) 26.9 (23.1-29.4) 0.012 Laboratory tests, median (p25-p75) CPR, mg/dL. 0.6 (0.2-1.0) 0.8 (0.3-1.4) 0.8 (0.4-1.7) 0.7 (0.4-1.2) 0.047 ESR, mm/H. 20.0 (15.0-36.2) 25.0 (14.5-34.0) 29.5 (17.0-44.2) 24.0 (15.0-36.0) 0.045 ACPA, U/mL. 2.7 (1.0-192.8) 20.3 (1.5-197.7) 99.1 (4.0-199.5) 114.1 (5.98-199.2) 0.001 RF IgG, U/mL. 3.7 (2.0-8.4) 4.0 (2.0-11.6) 5.5 (2.0-14.5) 7.0 (3.0-20.5) 0.003 RF IgM, U/mL. 81.4 (22.0-200.0) 200.0 (38.5-200.0) 200.0 (96.6-200.0) 200.0 (71.7-200.0) 0.000 RF IgA, U/mL. 16.4 (2.2-138.0) 43.6 (7.6-188.3) 66.5 (13.8-200.0) 128.2 (17.6-200.0) 0.000 Cardiovascular risk scales, %. median ASCVD 2.1 3.3 2.92 4.65 0.008 FRS-Lipids 6.3 8.1 7.95 9.3 0.028 FRS-BMI 8.55 10.95 11.85 12.6 0.023 SCORE 2 3 4.5 6 6 0.006 Q-RISK III 5.55 8.7 7.8 10.8 0.001 RRS 1.5 1.5 1.5 4.5 NS This table shows demographic and clinical characteristics. Quartiles were divided according to rheumatoid arthritis duration, meanwhile, each variable was described individually. BMI Body Mass Index; CRP C Reactive Protein; ESR Erythrocyte Sedimentation Rate; ACPA Anti–Citrullinated Protein Antibody; RF Rheumatoid Factor; ASCVD Atheroesclerotic Cardiovascular Disease; FRS Framingham Risk Score; RRS Reynolds Risk Score; SCORE 2 Systematic Coronary Risk Evaluation 2. Acknowledgements: NIL. Disclosure of Interests None Declared.