TY - JOUR

T1 - Prediction of cardiovascular events in rheumatoid arthritis using risk age calculations: evaluation of concordance across risk age models

AU - Wibetoe, Grunde

AU - Sexton, Joseph

AU - Ikdahl, Eirik

AU - Rollefstad, Silvia

AU - Kitas, George D.

AU - van Riel, Piet

AU - Gabriel, Sherine

AU - Kvien, Tore K.

AU - Douglas, Karen

AU - Sandoo, Aamer

AU - Arts, Elke E.

AU - Wallberg-Jonsson, Solveig

AU - Dahlqvist, Solbritt Rantapaa

AU - Karpouzas, George

AU - Dessein, Patrick H.

AU - Tsang, Linda

AU - El-Gabalawy, Hani

AU - Hitchon, Carol A.

AU - Pascual-Ramos, Virginia

AU - Contreas-Yanes, Irazu

AU - Sfikakis, Petros P.

AU - Gonzalez-Gay, Miguel A.

AU - Colunga-Pedraz, Iris J.

AU - Galarza-Delgado, Dionicio A.

AU - Azpiri-Lopez, Jose Ramon

AU - Crowson, Cynthia S.

AU - Semb, Anne Grete

PY - 2020/4/23

Y1 - 2020/4/23

N2 - Background In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics. Methods RA patients aged 30–70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up. Results A total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15–32% of patients. C-statistics ranged 0.68–0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results. Conclusions The cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.

AB - Background In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics. Methods RA patients aged 30–70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up. Results A total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15–32% of patients. C-statistics ranged 0.68–0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results. Conclusions The cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.

KW - Cardiovascular risk age

KW - Vascular age

KW - Cardiovascular disease

KW - Risk factors

KW - Rheumatoid arthritis

U2 - 10.1186/s13075-020-02178-z

DO - 10.1186/s13075-020-02178-z

M3 - Article

VL - 22

JO - Arthritis Research & Therapy

JF - Arthritis Research & Therapy

SN - 1478-6354

IS - 1

M1 - 90

ER -