Performance of four cardiovascular risk scales in chronic inflammatory rheumatic disease patients: 10-year follow-up data
Javier Llorca, Santos Castañeda, Iván Ferraz‐Amaro, Zulema Plaza, Fernando Sánchez‐Alonso, Carmen García‐Gómez, Carlos González‐Juanatey, Miguel Á. González‐Gay, CARMA Project Collaborative Group, José L Fernández Sueiro, José A Pinto-Tasende, de Eugenia González, María J González Fernández, Ramón Huguet Codina, Beatriz Yoldi Mercedes, Sara Marsal, Gabriela Ávila, Cayetano Alegre, Martina Steiner, Tatiana Cobo, Santiago Muñoz, Fernando Gamero, José García Torón, María P Moreno Gil, Antonio J Mas, Pilar Espiño, Inmaculada Ros, Mónica Ibáñez, Jesús Tornero, José A Piqueras, Raimon Sanmartí, Horacio Berman, Oscar Fontseré Patón, Benjamín Fernández Gutiérrez, Lydia Abasolo, José M Pina Salvador, María D Fábregas, Montserrat Romera, Joan M Nolla, Miren Uriarte-Ecenarro, Miriam García Arias, Jesús A García Vadillo, Rosario García de Vicuña, Eugenio Chamizo Carmona, Antonio Fernández Nebro, Inmaculada Ureña, María A Belmonte, María V Irigoyen, Olga Martínez González, Rebeca Belmonte Gómez, Pastora Granados Bautista, Azucena Hernández Sanz, José Santos Rey, Carmen O Sánchez González, Javier Bachiller, Antonio Zea, Francisco J Manero, Chesús Beltrán Audera, Marta Medrano, Ángela Pecondón, Celia Erausquin, Soledad Ojeda, Carlos Rodríguez-Lozano, Jesús Babío Herraiz, Francisco J López Longo, Indalecio Monteagudo, Javier del Pino, Ruth López González, Miguel A González-Gay, Alfonso Corrales, María Enriqueta Peiró, José M Senabre, José C Rosas, Isabel Rotés, Estefanía Moreno, Alba Erra, Javier Calvo, Amalia Rueda, Ingrid Möller, Isabel Rodríguez, Carmen Barbadillo, Enrique Raya, Pilar Morales, Ana Nieto, Ana Ruibal Escribano, Carmen García Gómez, Sergio Ros Expósito, Ginés Sánchez Nievas, Enrique Júdez Navarro, Manuela Sianes Fernández, Silvia Martínez Pardo, Manel Pujol, Beatriz Gónzález Alvarez, Alberto Cantabrana, Sagrario Bustabad, Esmeralda Delgado, Alejandro Muñoz, Sergio Rodríguez Montero, Javier Rivera Redondo, Teresa González Hernández
Abstract
OBJECTIVE: To compare the performance of QRESEARCH risk estimator (QRISK)3, Systematic Coronary Risk Evaluation (SCORE)2, Predicting Risk of cardiovascular disease EVENTs (PREVENT)-cardiovascular disease (CVD) and PREVENT-atherosclerotic cardiovascular disease (ASCVD) equations in predicting cardiovascular (CV) risk among individuals with chronic inflammatory rheumatic diseases (CIRD) enrolled in the Spanish CARMA project. METHODS: The study included CIRD patients from 67 Spanish hospitals (2010-2012) without prior CV events. After a 10-year follow-up, data were collected through medical records, patient/family contact or the Spanish National Statistics Institute. CV risk was analysed using Cox regression models adjusted for inflammatory disease. Model performance was evaluated using AIC, BIC, and Gönen and Heller's K. RESULTS: Among 2080 patients, 8.4% (174) experienced a first CV event. Those with CV events were older, had longer disease duration, higher body mass index and more frequent hypertension, diabetes or hypercholesterolemia. All four scales were strongly associated with CV events, with hazard ratios ranging from 1.04 (95% confidence interval [CI]: 1.03, 1.05) for QRISK3 to 1.13 (95% CI: 1.11, 1.16) for SCORE2. QRISK3 demonstrated better adjustment (lower AIC/BIC) but other scales showed higher concordance with actual events. QRISK3 and PREVENT-CVD accurately estimated 10-year CV risk for the overall cohort, while SCORE2 and PREVENT-ASCVD underestimated risk. Among rheumatoid arthritis patients, QRISK3 overestimated risk, whereas PREVENT-CVD was the only scale to perform reliably. CONCLUSIONS: All scales effectively distinguished between low and high CV risk. PREVENT-CVD emerges as a valuable tool for assessing CV risk in CIRD patients.