Article Text
PDF
Abstract
Background Cardiovascular (CV) risk stratification for patients with rheumatoid arthritis (RA) should facilitate evidence-based management. Prior work has derived an internally validated a CV risk score, the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), using US data. The aim of this study was to perform an external validation among unselected patients with RA from Europe.
Methods Three large, partially overlapping, cohorts of patients with RA from the Swedish Rheumatology Quality register were identified for external validation, two with information on smoking and two with close to 10 years of median follow-up. The 10 -year rate of first CV events was assessed using the Kaplan-Meier method. The performance of ERS-RA was assessed using C-index and comparisons of observed versus predicted risks.
Results The C-index for ERS-RA varied across the three RA cohorts, from 0.75 to 0.78. Predicted risks corresponded well to observed risks among individuals with ≤10 % observed 10- year CV risk, but underestimated risk in individuals with a higher observed risk. In the absence of data on smoking, ERS-RA underestimated the CV risk by 3.3%, whereas in the cohorts including data on smoking, the calibration was within 1% (0.06% and 0.7%). In the clinically relevant risk intervals (<5%, 5.0%–<7.5%, 7.5%–<10%), ERS-RA performed well.
Conclusions In an unselected Swedish population with RA, ERS-RA performed well, although the 10-year CV risk was underestimated in high-risk groups and in the absence of data on smoking. ERS-RA could be considered as a risk stratification tool for targeted preventive interventions in clinical rheumatology practice.
- rheumatoid arthritis
- cardiovascular risk
- risk prediction
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0
Statistics from Altmetric.com
Footnotes
Contributors LL had full access to all of the data used for analyses in this study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. All authors are justifiably credited with authorship, according to the authorship criteria. Study concept and design: LL, PU, KPL, DHS, JA. Acquisition of data: JA. Statistical analysis: LL, PU, JA. Analysis and interpretation of data: LL, PU, KPL, JDG, CJE, DHS. Drafting of manuscript: LL, PU, JA. Critical revision of manuscript and final approval given: LL, PU, KPL, JDG, CJE, DHS. Obtained funding: JA. Study supervision: DHS, JA.
Funding Västerbottens Läns Landsting (ALF), the Swedish Rheumatism Association, the Heart Foundation of Northern Sweden, the Swedish Society of Medicine, King Gustaf V's 80-year foundation. KPL is supported by the NIH R01 HL127118.
Disclaimer Funders had no impact on the design or interpretation of the study or its results.
Competing interests LL has received personal fees for educational activities by Pfizer. JA has or has had research agreements with Abbvie, BMS, MS, Pfizer, Roche, Astra-Zeneca, Lilly and UCB, mainly in the context of safety monitoring of biologics via ARTIS/The Swedish Biologics Register. DHS receives salary support through his hospital from unrelated research agreements with Amgen, Abbvie, Pfizer, Bristol Myers Squibb, Genentech and Corrona.
Patient consent Not required.
Ethics approval The Ethical Committee in Stockholm, Sweden.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Access to the national register data used for this study is granted on a restrictive basis and may not be shared without additional specific permissions from the Swedish register-holding authorities.