title: Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms.
abstract: OBJECTIVE
  Predictive performance of cardiovascular disease (CVD) risk calculators appears suboptimal in rheumatoid arthritis (RA). A disease-specific CVD risk algorithm may improve CVD risk prediction in RA. The objectives of this study are to adapt the Systematic COronary Risk Evaluation (SCORE) algorithm with determinants of CVD risk in RA and to assess the accuracy of CVD risk prediction calculated with the adapted SCORE algorithm.
  
  
  METHODS
  Data from the Nijmegen early RA inception cohort were used. The primary outcome was first CVD events. The SCORE algorithm was recalibrated by reweighing included traditional CVD risk factors and adapted by adding other potential predictors of CVD. Predictive performance of the recalibrated and adapted SCORE algorithms was assessed and the adapted SCORE was externally validated.
  
  
  RESULTS
  Of the 1016 included patients with RA, 103 patients experienced a CVD event. Discriminatory ability was comparable across the original, recalibrated and adapted SCORE algorithms. The Hosmer-Lemeshow test results indicated that all three algorithms provided poor model fit (p<0.05) for the Nijmegen and external validation cohort. The adapted SCORE algorithm mainly improves CVD risk estimation in non-event cases and does not show a clear advantage in reclassifying patients with RA who develop CVD (event cases) into more appropriate risk groups.
  
  
  CONCLUSIONS
  This study demonstrates for the first time that adaptations of the SCORE algorithm do not provide sufficient improvement in risk prediction of future CVD in RA to serve as an appropriate alternative to the original SCORE. Risk assessment using the original SCORE algorithm may underestimate CVD risk in patients with RA.
authors.affiliation: Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: E E A
authors.initials: EE
authors.lastname: Arts
authors.affiliation: Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Popa
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: A A
authors.initials: AA
authors.lastname: Den Broeder
authors.affiliation: Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Donders
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sandoo
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.
authors.forename: T
authors.initials: T
authors.lastname: Toms
authors.affiliation: Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Rollefstad
authors.affiliation: Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: E
authors.initials: E
authors.lastname: Ikdahl
authors.affiliation: Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: A G
authors.initials: AG
authors.lastname: Semb
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.
authors.forename: G D
authors.initials: GD
authors.lastname: Kitas
authors.affiliation: Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: P L C M
authors.initials: PL
authors.lastname: Van Riel
authors.affiliation: Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Fransen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D001685:Biological Factors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010456:Peptides, Cyclic / Q000276:immunology; D016016:Proportional Hazards Models; D012217:Rheumatoid Factor / Q000276:immunology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor
keywords: Cardiovascular Disease; Disease Activity; Rheumatoid Arthritis