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Does RA Inflammation Impact Estimated CV Risk?

Arthritis Rheumatol; ePub 2018 Apr 20; Yu, et al

Publish date:

A recent study found no significant change in cardiovascular (CV) risk estimates using validated general population CV risk calculators except for Reynolds Risk Score (RRS). These data suggest that CV risk may be modulated by changes in inflammation in RA, not typically considered using existing CV risk calculators. Researchers studied participants in a prospective RA cohort (n=180; mean age 57.8 years, 85% female, 70% seropositive), including participants who experienced a decrease or increase of ≥10mg/L in C‐reactive protein (CRP) at 2 consecutive time points, 1 year apart. They calculated 10‐year CV risk using the following calculators: Framingham Risk Score, 2013 American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease Risk Score, RRS, and QRISK2. Paired t‐tests were performed to compare risk scores at baseline and 1‐year follow‐up among participants in the 2 groups. They found:

  • Of the calculators studied, only RRS was sensitive to changes in inflammation; an increase of inflammation was associated with increased estimated CV risk.
  • Only RRS was correlated with changes in pro‐B-type natriuretic peptide (BNP) (r=0.17).

Citation:

Yu Z, Yang N, Everett BM, et al. Impact of changes in inflammation on estimated 10‐year cardiovascular risk in rheumatoid arthritis. [Published online ahead of print April 20, 2018]. Arthritis Rheumatol. doi:10.1002/art.40532.

Commentary:

This study discussed the use of validated cardiovascular (CV) risk calculators to determined CV risk in a rheumatoid arthritis (RA cohort and found that CV risk may be influenced by changes in inflammation in RA. Other methods for calculating CV risk can be used in future studies, including those for hypertension and high low-density lipoprotein (LDL). According to this study, only Reynolds Risk Score (RRS) was sensitive to changes in inflammation and an increase of inflammation was associated with increased estimated CV risk. Further studies need to be conducted in order to determine the ways that inflammation in RA may increase CV risk and more participants should be studied to obtain validated results.—Harold E. Paulus, MD, Emeritus Professor, University of California, Los Angeles; Division of Rheumatology

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