title: Comparison of cardiovascular risk algorithms in patients with vs without rheumatoid arthritis and the role of C-reactive protein in predicting cardiovascular outcomes in rheumatoid arthritis.
abstract: The aims were to compare the performance of cardiovascular risk calculators, Framingham Risk Score (FRS) and QRISK2, in RA and matched non-RA patients and to evaluate whether their performance could be enhanced by the addition of CRP.
  
  
  
  We conducted a retrospective analysis, using a clinical practice data set linked to Hospital Episode Statistics (HES) data from the UK. Patients presenting with at least one RA diagnosis code and no prior cardiovascular events were matched to non-RA patients using disease risk scores. The overall performance of the FRS and QRISK2 was compared between cohorts, and assessed with and without CRP in the RA cohort using C-Index, Akaike Information Criterion (AIC) and the net reclassification index (NRI).
  
  
  
  Four thousand seven hundred and eighty RA patients met the inclusion criteria and were followed for a mean of 3.8 years. The C-Index for the FRS in the non-RA and RA cohort was 0.783 and 0.754 (P < 0.001) and that of the QRISK2 was 0.770 and 0.744 (P < 0.001), respectively. Log[CRP] was positively associated with cardiovascular events, but improvements in the FRS and QRISK2 C-Indices as a result of inclusion of CRP were small, from 0.764 to 0.767 (P = 0.026) for FRS and from 0.764 to 0.765 (P = 0.250) for QRISK2. The NRI was 3.2% (95% CI: -2.8, 5.7%) for FRS and -2.0% (95% CI: -5.8, 4.5%) for QRISK2.
  
  
  
  The C-Index for the FRS and QRISK2 was significantly better in the non-RA compared with RA patients. The addition of CRP in both equations was not associated with a significant improvement in reclassification based on NRI.
authors.affiliation: Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA.
authors.forename: Evo
authors.initials: E
authors.lastname: Alemao
authors.affiliation: Real World Strategy & Analytics, MAPI, Nanterre, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Cawston
authors.affiliation: Real World Strategy & Analytics, MAPI, Nanterre, France.
authors.forename: François
authors.initials: F
authors.lastname: Bourhis
authors.affiliation: Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.|Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Maiwenn
authors.initials: M
authors.lastname: Al
authors.affiliation: Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.|Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Maureen
authors.initials: M
authors.lastname: Rutten-van Molken
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Liao
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002097:C-Reactive Protein / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Cox; cardiovascular; net reclassification index; retrospective; rheumatoid arthritis; risk algorithm; survival