title: Cardiovascular risk stratification in rheumatic diseases: carotid ultrasound is more sensitive than Coronary Artery Calcification Score to detect subclinical atherosclerosis in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To determine the ability of Coronary Artery Calcification Score (CACS) and carotid ultrasonography in detecting subclinical atherosclerosis in rheumatoid arthritis (RA).
  
  
  METHODS
  A set of 104 consecutive RA patients without history of cardiovascular (CV) events were studied to determine CACS, carotid intima-media thickness (cIMT) and plaques. Systematic Coronary Risk Evaluation (SCORE) modified according to the EULAR recommendations (mSCORE) was also assessed.
  
  
  RESULTS
  The mean disease duration was 10.8 years, 72.1% had rheumatoid factor and/or anti-CCP positivity and 16.4% extra-articular manifestations. Nine were excluded because they had type 2 diabetes mellitus or chronic kidney disease. CV risk was categorised in the remaining 95 RA patients according to the mSCORE as follows: low (n=21), moderate (n=60) and high/very high risk (n=14). Most patients with low mSCORE (16/21; 76.2%) had normal CACS (zero), and none of them CACS>100. However, a high number of patients with carotid plaques was disclosed in the groups with CACS 0 (23/40; 57.5%) or CACS 1-100 (29/38; 76.3%). 72 (75.8%) of the 95 patients fulfilled definitions for high/very high CV as they had an mSCORE ≥5% or mSCORE <5% plus one of the following findings: severe carotid ultrasonography findings (cIMT>0.9 mm and/or plaques) or CACS>100. A CACS>100 showed sensitivity similar to mSCORE (23.6% vs 19.4%). In contrast, the presence of severe carotid ultrasonography findings allowed identifying most patients who met definitions for high/very high CV risk (70/72; sensitivity 97.2% (95% CI 90.3 to 99.7)).
  
  
  CONCLUSIONS
  Carotid ultrasonography is more sensitive than CACS for the detection of subclinical atherosclerosis in RA.
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, , Santander, Cantabria, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Corrales
authors.forename: José A
authors.initials: JA
authors.lastname: Parra
authors.forename: Carlos
authors.initials: C
authors.lastname: González-Juanatey
authors.forename: Javier
authors.initials: J
authors.lastname: Rueda-Gotor
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications / Q000175:diagnosis*
keywords: Atherosclerosis; Cardiovascular Disease; Rheumatoid Arthritis; Ultrasonography