Carotid-femoral pulse wave velocity improves cardiovascular risk prediction beyond SCORE2 in autoimmune rheumatic diseases: a 7-year follow-up study.

OBJECTIVES

To evaluate the prognostic value of carotid-femoral pulse wave velocity (cfPWV), a marker of aortic stiffness, for cardiovascular events (CVEs) in patients with autoimmune rheumatic diseases (ARDs) and to compare its performance with the Systematic Coronary Risk Evaluation 2 (SCORE2).

METHODS

This retrospective cohort study included patients with rheumatoid arthritis, systemic sclerosis and spondyloarthritis who underwent clinically indicated baseline non-invasive cfPWV assessment between 2012 and 2017 because of at least one additional cardiovascular risk factor. CV risk was estimated using SCORE2 and SCORE2-OP in eligible patients. Incident CVEs were ascertained through structured interviews over a median 7-year follow-up. Associations were evaluated using Cox proportional hazards models and predictive performance using receiver operating characteristic analysis.

RESULTS

Among 143 patients, 20 CVEs occurred. Baseline cfPWV was higher in patients who developed CVEs versus those who did not (10.06±2.16 m/s vs 8.8±2.3 m/s; p=0.024). SCORE2 did not differ between groups (6.55±3.90% vs 5.61±4.39%, p=0.35). cfPWV demonstrated strong discriminatory capacity for CVEs (area under the curve (AUC) 0.84; 95% CI (0.73 to 0.93), sensitivity 0.87, specificity 0.73), outperforming SCORE2 (AUC 0.56; 95% CI (0.41 to 0.72), sensitivity 0.60, specificity 0.69). In age-adjusted Cox regression, cfPWV remained a significant predictor of CVEs (HR 1.19, 95% CI (1.00 to 1.39); p=0.047). cfPWV correlated with baseline age (p<0.001), mean arterial pressure (p=0.013) and C reactive protein (p=0.011).

DISCUSSION: cfPWV is an independent predictor of future CVEs in patients with ARDs and outperforms SCORE2 in long-term risk prediction. Given its non-invasive nature, cfPWV may provide incremental value for CV risk stratification in this high-risk population.