title: Utility of different cardiovascular disease prediction models in rheumatoid arthritis.
abstract: BACKGROUND
  Rheumatoid arthritis comes with a 30% higher probability for cardiovascular disease than the general population. Current guidelines advocate for early and aggressive primary prevention and treatment of risk factors in high-risk populations but this excess risk is under-addressed in RA in real life. This is mainly due to difficulties met in the correct risk evaluation. This study aims to underline the differences in results of the main cardiovascular risk screening models in the real life rheumatoid arthritis population.
  
  
  METHODS
  In a cross-sectional study, patients addressed to a tertiary care center in Romania for an biannual follow-up of rheumatoid arthritis and the ones who were considered free of any cardiovascular disease were assessed for subclinical atherosclerosis. Clinical, biological and carotidal ultrasound evaluations were performed. A number of cardiovascular disease prediction scores were performed and differences between tests were noted in regard to subclinical atherosclerosis as defined by the existence of carotid intima media thickness over 0,9 mm or carotid plaque.
  
  
  RESULTS
  In a population of 29 Romanian rheumatoid arthritis patients free of cardiovascular disease, the performance of Framingham Risk Score, HeartSCORE, ARIC cardiovascular disease prediction score, Reynolds Risk Score, PROCAM risk score and Qrisk2 score were compared. All the scores under-diagnosed subclinical atherosclerosis. With an AUROC of 0,792, the SCORE model was the only one that could partially stratify patients in low, intermediate and high-risk categories. The use of the EULAR recommended modifier did not help to reclassify patients.
  
  
  CONCLUSIONS
  The only score that showed a statistically significant prediction capacity for subclinical atherosclerosis in a Romanian rheumatoid arthritis population was SCORE. The additional calibration or the use of imaging techniques in CVD risk prediction for the intermediate risk category might be warranted.
authors.affiliation: Strasbourg Medical University, Civil Hospital Strasbourg, Internal Medicine Department, France ; "Carol Davila" University of Medicine and Pharmacy, "Cantacuzino" Hospital, Internal Medicine and Rheumatology Department, Bucharest, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Purcarea
authors.affiliation: Civil Hospital Strasbourg, Internal Medicine Department, France.
authors.forename: S
authors.initials: S
authors.lastname: Sovaila
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, "Cantacuzino" Hospital, Internal Medicine and Rheumatology Department, Bucharest, Romania.
authors.forename: G
authors.initials: G
authors.lastname: Udrea
authors.affiliation: "Grigore T. Popa" University of Medicine and Pharmacy, Rheumatology Department, Iasi, Romania.
authors.forename: E
authors.initials: E
authors.lastname: Rezus
authors.affiliation: Geomed-Klinik Hospital, Gerolzhofen, Internal Medicine Department, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gheorghe
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital, Neurology Department, Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Tiu
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, "Cantacuzino" Hospital, Internal Medicine and Rheumatology Department, Bucharest, Romania.
authors.forename: V
authors.initials: V
authors.lastname: Stoica
mesh_terms: D019540:Area Under Curve; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012372:ROC Curve; D012015:Reference Standards; D012307:Risk Factors
keywords: SCORE; cardiovascular disease prediction models; carotid intima media; rheumatoid arthritis; risk assessment