title: The 2013 ACC/AHA 10-year atherosclerotic cardiovascular disease risk index is better than SCORE and QRisk II in rheumatoid arthritis: is it enough?
abstract: OBJECTIVE
  To determine the ability of the new American College of Cardiology and American Heart Association (ACC/AHA) 10-year atherosclerotic cardiovascular disease (ASCVD) risk algorithm in detecting high cardiovascular (CV) risk, RA patients identified by carotid ultrasonography (US) were compared with Systematic Coronary Risk Evaluation (SCORE) and QRisk II algorithms.
  
  
  METHODS
  SCORE, QRisk II, 2013 ACC/AHA 10-year ASCVD risk and EULAR recommended modified versions were calculated in 216 RA patients. In sonographic evaluation, carotid intima-media thickness >0.90 mm and/or carotid plaques were used as the gold standard test for subclinical atherosclerosis and high CV risk (US+).
  
  
  RESULTS
  Eleven (5.1%), 15 (6.9%) and 44 (20.4%) patients were defined as having high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. Fifty-two (24.1%) patients were US + and of those, 8 (15.4%), 7 (13.5%) and 23 (44.2%) patients were classified as high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. The ACC/AHA 10-year ASCVD risk index better identified US + patients than SCORE and QRisk II (P < 0.0001). With EULAR modification, reclassification from moderate to high risk occurred only in two, five and seven patients according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively.
  
  
  CONCLUSIONS
  The 2013 ACC/AHA 10-year ASCVD risk estimator was better than the SCORE and QRisk II indices in RA, but still failed to identify 55% of high risk patients. Furthermore adjustment of threshold and EULAR modification did not work well.
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and ozengs@yahoo.com.
authors.forename: Gulsen
authors.initials: G
authors.lastname: Ozen
authors.affiliation: Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sunbul
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and.
authors.forename: Pamir
authors.initials: P
authors.lastname: Atagunduz
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and.
authors.forename: Haner
authors.initials: H
authors.lastname: Direskeneli
authors.affiliation: Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Kursat
authors.initials: K
authors.lastname: Tigen
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and.
authors.forename: Nevsun
authors.initials: N
authors.lastname: Inanc
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000465:Algorithms; D000572:American Heart Association; D000704:Analysis of Variance; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012955:Societies, Medical; D018709:Statistics, Nonparametric; D014481:United States
keywords: ACC/AHA 10-year ASCVD; QRisk II; SCORE; cardiovascular risk estimation; carotid intima-media thickness