The expanded cardiovascular risk prediction score as a cardiovascular mortality predictor in rheumatoid arthritis.

OBJECTIVES

We aimed to examine the performance of the expanded cardiovascular (CV) risk prediction score for rheumatoid arthritis (ERS-RA), the Framingham CV risk score and the carotid intima-media thickness (IMT) as predictors of CV mortality in patients with rheumatoid arthritis (RA).

METHODS

We studied 1194 patients with RA who had an ultrasound measurement of the carotid IMT and who had clinical information to calculate the ERS-RA and the Framingham score. Deaths were confirmed by death certificate and attributed to a CV cause if the immediate or underlying cause of death was due to ICDM-9 codes 390-459. We compared areas under receiver operator characteristic curves (ROC AUC) and examined reclassification tables for the performance of each scale to correctly predict CV deaths.

RESULTS

Patients were observed for 10,063 person-years, during which 271 patients died (22.6%), for an overall mortality rate of 2.7 deaths per 100 person-years (95% CI 2.4, 3.0). A CV cause of death was identified in 139 patients (11.6%), for a CV mortality rate of 1.4 per 100 person-years (1.2, 1.6). ROC AUCs were 0.72 (95% CI 0.68, 0.76) for the Framingham scale, 0.76 (95% CI 0.72, 0.81) for the carotid IMT and 0.84 (95% CI 0.81, 0.88) for the ERS-RA. Compared to the Framingham scale the ERS-RA correctly reclassified 6% of patients (p=0.02), while the carotid IMT correctly reclassified 5% (p=0.003).

CONCLUSIONS

The ERS-RA was superior to the Framingham scale in the prediction of CV mortality in patients with RA.