Key result
Abdominal obesity significantly attenuated the accuracy of the Framingham cardiovascular risk score in predicting cardiovascular events in patients with rheumatoid arthritis (AUC 0.660 vs 0.952, p=0.002).
Why the study?
Because underweight rheumatoid arthritis patients incur greater cardiovascular mortality than overweight or obese patients, investigators explored whether obesity confounds cardiovascular risk estimates and if noninvasive coronary atherosclerosis assessment and cardiac damage biomarkers optimize risk prediction.
Does the addition of hs-cTnI and CCTA plaque assessment improve cardiovascular risk prediction in obese patients with rheumatoid arthritis?
Cohort (n=150)
No
Does the addition of hs-cTnI and CCTA plaque assessment improve cardiovascular risk prediction in obese patients with rheumatoid arthritis?
In patients with rheumatoid arthritis, abdominal obesity attenuates the accuracy of the Framingham cardiovascular risk score, but risk prediction can be significantly improved by incorporating hs-cTnI and CCTA plaque burden.
May warrant caution applying standard CV risk scores to obese RA patients; leaves open whether noninvasive atherosclerosis assessment refines prediction.
Objectives. Underweight patients with rheumatoid arthritis incur greater total and cardiovascular mortality compared to overweight or obese. We explored whether obesity confounded cardiovascular risk estimates and the potential utility of noninvasive coronary atherosclerosis assessment and cardiac damage biomarkers in optimizing risk prediction in obese patients with rheumatoid arthritis. Methods. We evaluated 150 participants undergoing screening atherosclerosis evaluation with coronary computed tomography angiography and follow-up over 6.0±2.4 years. Framingham 2008 modified general cardiovascular risk score was computed at baseline. Obesity was defined as waist circumference >88 cm in females and >102 cm in males. Serum highly-sensitive cardiac troponin I (hs-cTnI) and leptin were measured at baseline. Results. An interaction between the Framingham risk score and obesity on cardiovascular risk was observed (p=0.032); lower estimates were seen in obese (area under the curve-AUC 0.660, 95% CI 0.487-0.832) vs. non-obese patients (AUC 0.952, 95% CI 0.897-1.007, p=0.002). Likewise, risk estimates were inferior in patients with high (>22.1 ng/ml) vs. low leptin (AUC 0.618, 95% CI 0.393-0.842 vs. 0.874, 95% CI 0.772-0.976, p=0.042). In obese patients, sequential addition of the top highly-sensitive cardiac troponin I tertile values and extensive atherosclerotic plaque (>5 segments) information to a base model including the Framingham risk score alone significantly improved risk estimates, based on changes in net reclassification index (1.093 95% CI 0.517-1.574), integrated discrimination improvement (0.188, 95% CI 0.060-0.526), and AUC (0.179, 95% CI 0.058-0.378, p=0.02). The final, combined model accurately predicted 83.9% of incident cardiovascular events. Conclusion. Obesity attenuated cardiovascular risk estimate accuracy in patients with rheumatoid arthritis. Risk optimization employing non-invasive assessment of coronary atherosclerosis burden and serum cardiac damage biomarkers may warrant further study.
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Karpouzas et al. (2023) conducted a cohort in Rheumatoid arthritis (n=150). Abdominal obesity vs. Non-obese patients was evaluated on Accuracy of Framingham cardiovascular risk score (AUC) for predicting incident cardiovascular events (Difference in AUC 0.292, 95% CI 0.111-0.473, p=0.002). Abdominal obesity significantly attenuated the accuracy of the Framingham cardiovascular risk score in predicting cardiovascular events in patients with rheumatoid arthritis (AUC 0.660 vs 0.952, p=0.002).
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