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Clin Rheumatol. 2018 Feb;37(2):467-474. doi: 10.1007/s10067-017-3860-x. Epub 2017 Oct 9.

Discordance of the Framingham cardiovascular risk score and the 2013 American College of Cardiology/American Heart Association risk score in systemic lupus erythematosus and rheumatoid arthritis.

Author information

1
Department of Medicine, Division of Rheumatology, University of California, San Francisco, 513 Parnassus Avenue, Medical Sciences Room S847, Box 0500, San Francisco, CA, 94143, USA. kashif.jafri@ucsf.edu.
2
Department of Medicine, Division of Rheumatology, University of Pennsylvania, White Building, Room 5024, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
3
Department of Medicine, Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, M1177B, San Francisco, CA, 94143, USA.
4
Department of Medicine, Division of Rheumatology, University of California, San Francisco, 513 Parnassus Avenue, Medical Sciences Room S847, Box 0500, San Francisco, CA, 94143, USA.
5
Department of Medicine, Division of Rheumatology, University of California, San Francisco, UCSF Box 0500, 513 Parnassus Avenue, San Francisco, CA, 94143, USA.
6
Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
7
Department of Medicine, Division of Rheumatology, University of California, San Francisco, UCSF Box 0920, 3333 California Street, San Francisco, CA, 94143, USA.
8
Department of Medicine, Division of Rheumatology, University of California, San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143, USA.
9
Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco VA Medical Center, 4150 Clement St,, Mailstop 111R, San Francisco, CA, 94121, USA.

Abstract

Despite the increasing use of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular (CV) risk score in clinical practice, few studies have compared this score to the Framingham risk score among rheumatologic patients. We calculated Framingham and 2013 ACC/AHA risk scores in subjects with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and assessed demographic, CV, and rheumatologic characteristics associated with discordant scores (high-risk ACC/AHA scores but low-risk Framingham scores). SLE and RA subjects drawn from two population-based cohort studies were assessed during in-person study visits. We used chi-squared tests and t tests to examine the association of discordant CV risk scores with baseline characteristics. Eleven (7.0%) of 157 SLE subjects and 11 (11.5%) of 96 RA subjects had discordant CV risk scores with high ACC/AHA scores and low Framingham scores. These findings did not significantly change when a 1.5 multiplier was applied to the Framingham score. Rheumatologic disease duration, high-sensitivity CRP levels, African-American race, diabetes, current use of anti-hypertensive medication, higher age, and higher systolic blood pressure were each significantly associated with discordant risk scores. Approximately 10% of SLE and RA subjects had discordant 10-year CV risk scores. Our findings suggest that the use of the 2013 ACC/AHA risk score could result in changes to lipid-lowering therapy recommendations in a significant number of rheumatologic patients. Prospective studies are needed to compare which score better predicts CV events in rheumatologic patients, especially those with risk factors associated with discordant risk scores.

KEYWORDS:

Cardiovascular risk score; Rheumatoid arthritis; Systemic lupus erythematosus

PMID:
28993952
PMCID:
PMC5908810
DOI:
10.1007/s10067-017-3860-x
[Indexed for MEDLINE]
Free PMC Article

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