Assessment of cardiovascular risk in patients with crystal-induced arthritides and rheumatoid arthritis by the ATP III and Reynolds Risk Score

Cardiovascular risk (CVR) in patients with calcium pyrophosphate crystal deposition disease (CPPD) has not been studied, and the optimal method for assessing it has not been established yet.Objective: Evaluation of CVR and comparison of results using Adult Treatment Panel III (ATP III) and Reynolds Risk Score (RRS) scales in patients with CPPD, gout, rheumatoid arthritis (RA) and in the control group.Materials and methods: Cross-sectional, single-center study performed by case-control method. There are 42 patients with CPPD in main group, 42 patients with gout and RA in the comparison groups are, 42 healthy volunteers in the control group. The survey included measurements of anthropometric measures, blood pressure (BP), serum glucose, creatinine, cholesterol (TC), high density lipoproteins (HDL), low density lipoproteins (LDL), C-reactive protein (CRP). CVR was assessed on ATP III and RRS scales, comparison of its evaluation results was carried out between groups and between scales within groups.Results and discussion: Most of the parameters in the compared groups did not differ. However, HDL CS levels were significantly higher in patients with CPPD and in the control group than in RA and gout (p<0.05). In addition, in patients with gout and RA, systolic BP was higher than in CPPD and in control (p<0.05).CRP in CPPD was lower than in gout and RA and was not significantly different from this indicator in the control group. Its median was 3.8 [1.0; 12.4], 8.5 [4.1; 12.9] (р <0.05), 8.6 [4.1; 20.6] (р<0.05), 1.5 [0.8; 2.6] mg/l (p>0.05). The CRP > 5 mg/L in CPPD and in the control group was greater than in RA (p<0.05) and gout (p<0.05), but CRP≥5 mg/L was determined in 18 patients (43%) with CPPD and only in 3 (7%) people in the control group (p<0.05). A high and very high risk of cardiovascular disease (CVD) on the ATP III scale in CPPD was noted in 5 (12%) in gout – in 7 (17%), in RA – in 9 (21%) and in the control group – in 8 (19%) cases. Its frequency in all groups was comparable.A high and very high risk of CVD for RRS was identified in 9 (21%), 14 (33%), 12 (29%) and 7 (17%) cases, respectively.Conclusions: CVR under CPPD, RA and gout is comparable and quite high. The RRS scale may be a more objective method of assessing CVD risk in patients with CPPD, gout and RA.

SAT0393 DISCREPANCY IN THE CARDIOVASCULAR RISK SEVERITY CALCULATED USING DIFFERENT RATING SCALES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:Cardiovascular risk (CVR) in patients (pts) with axial spondyloarthritis (axSpA) exceed the populational level. However, it remains unclear, which of the cardiovascular risk assessment systems is the most accurate in cases of chronic inflammation..Objectives:of the current study were to assess the CVR in pts with axSpA and to compare different cardiovascular risk scales in these pts.Methods:The study included 118 patients at the age of 25-65 years with diagnosis of axSpA fulfilling ASAS criteria (2009) from St. Petersburg’ axSpA register. Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated. For the pts below 40 years old only QRISK3 was calculated.Results:Mean age of the pts was 44.3±11.1 years; 91(77.1%) pts were males, HLA-B27 positive – 83 (70.3%) of the pts; mean disease duration 13.0±8.3 years. Mean value of SCORE was 2.78±1.89%, of RRS – 5.28±3.31%, of QRISK3 – 7.91±3.8% (figure 1). Cronbach’s alpha for the scales was 0.873.Figure 1.Cardiovascular risk evaluation indices in patients with axial spondyloarthritis, n=118 for QRISK3, n=72 for SCORE and RRS.High CVR (≥5 %) was found in 14 (11,7%) of the pts according to the SCORE, in 65 (55,1%) of the pts according to the RRS, and in 81 (69%) of the pts according to the QRISK3. Ranking of CVR severity did not match in SCORE and QRISK3 indices in 83.72% of cases, in SCORE and RRS – in 51.16% of cases, and in QRISK3 and RRS in 8% of cases. The SCORE index showed the lower values of the expected risk as compared to the QRISK3 and RRS (figure1).In axSpA pts at age 25-40 years old (n=46, mean age 32.6±4.0 years, males 36 (78.3%)), mean value of QRISK3 was 1.16±0.99 %; in 14 from 46 (30.4%) of those pts increased CVR was registered (figure 2).Figure 2.QRISK3 index in axSpA patients 25-40 years old, n=46Conclusion:There was a discrepancy in the severity of CVR calculated using different rating scales in axSpA patients. The SCORE index showed lower values of CVR as compared to the QRISK3 and RRS, which hypothetically could be the consequence of CVR underestimation. QRISK3 demonstrated the highest CVR and was the only index useful in pts below 40 years old. To exclude hyper- or underestimation of CVR calculation more data about CVR calculations and frequency of CV events, occurring in axSpA patients are needed.Disclosure of Interests:Elizaveta Vasilenko: None declared, V Mazurov: None declared, Ruzana Samigullina: None declared, Anna Dadalova: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi

The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls

Objective.This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls.Methods.Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included.Results.In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent.Conclusion.This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.

Is Lipoprotein-Associated Phospholipase A2 a Link between Inflammation and Subclinical Atherosclerosis in Rheumatoid Arthritis?

Objective. Lipoprotein-associated phospholipase A2 (Lp-PLA2), a marker of vascular inflammation, is associated with cardiovascular disease. This prospective study of an inception cohort aimed to investigate whether the level of Lp-PLA2 is associated with subclinical atherosclerosis in patients with rheumatoid arthritis (RA).Methods. Patients from northern Sweden diagnosed with early RA were consecutively recruited into an ongoing prospective study. From these, all patients ≤60 years (n=71) were included for measurements of subclinical atherosclerosis at inclusion (T0) and five years later (T5). Forty age- and sex-matched controls were included. The patients were clinically assessed, SCORE, Reynolds Risk Score, and Larsen score were calculated, and blood samples were drawn from all individuals at T0 and T5.Results. There was no significant difference in the level of Lp-PLA2 between patients with RA and controls (p>0.05). In simple linear regression models among patients with RA, Lp-PLA2 at T0 was significantly associated with intima media thickness (IMT) at T0 and T5, flow mediated dilation (FMD) at T0 and T5, ever smoking, male sex, HDL-cholesterol (inversely), non-HDL-cholesterol, SCORE, Reynolds Risk Score, and Larsen score (p<0.05).Conclusion. In this cohort of patients with early RA, the concentration of Lp-PLA2 was associated with both subclinical atherosclerosis and disease severity.

Abstract P320: Discordance of Framingham Risk Score and Reynolds Risk Score to Global Vascular Risk Score: Results from the Hispanic Community Health Study/Study of Latinos

Introduction: The Framingham Risk Score (FRS) is a coronary heart disease (CHD) risk model established using an ethnically homogeneous population that predicts 10-year hard CHD events, myocardial infarction (MI) and coronary death. The Reynolds Risk Score (RRS) and Global Vascular Risk Score (GVRS) are validated CHD risk models that, in addition to hard CHD events, predict stroke and other CHD outcomes. In addition to major CHD risk factors, RRS adds systemic inflammation and family history of MI as GVRS adds behavioral and anthropometric measures. This study aims to compare agreement of RRS and GVRS with FRS among Hispanic/Latino adults and to describe discordance in RRS and GVRS with FRS categories, by socio-demographic characteristics. Methods: HCHS/SOL is a population-based cohort study of Hispanics/Latinos in four US communities. The analytic sample includes 6,058 non-diabetic participants 45-74 years of age with no past history of CHD and stroke who underwent comprehensive baseline examination. 10-year hard CHD risk score was calculated; participants were categorized as low (<10%), moderate (10-<20%), and high (≥20%) risk. Kappa scores were calculated to compare agreement of RRS and GVRS with FRS. Socio-demographic characteristics of concordance and discordance were characterized overall; multinomial logistic regression models was used to examine age-sex-adjusted likelihood of in discordance by these factors. Results: Mean age of the participants was 55 (SE=0.15) years, 54.3% were women, 41% had family history of CHD, and 90% were foreign born. Overall, 4,805 (74%) had low FRS, 1,143 (24%) had moderate FRS, and 110 (2%) had high FRS. There was poor agreement between RRS and FRS (Kappa=0.16, P<0.01) and fair agreement between GVRS and FRS (Kappa=0.36, P<0.01). In age-sex-adjusted analyses, RRS and GVRS were both more likely to classify persons of moderate and high risk who are between the ages of 60-74; GVRS classified more moderate and high risk women than the FRS. RRS and GVRS discordance with FRS was not associated with nativity and length of time in US. Conclusion: Significant discordance was observed between RRS and GVRS compared to FRS. Among Hispanic/Latino adults, use of RRS or GVRS may be more inclusive in classifying older age adults and women at high 10-year CHD risk.