Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis
Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis
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DOI：
10.1136/annrheumdis-2013-204024
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发表时间：
2015-04-01
影响因子：
27.4
通讯作者：
Fransen, J.
中科院分区：
文献类型：
--
作者：
Arts, E. E. A.;Popa, C.;Fransen, J.
目的本研究旨在评估4种已建立的心血管（CV）风险模型对欧洲类风湿关节炎（RA）患者10年内致命性和非致命性CV疾病风险的预测能力。通过受试者工作特征曲线下面积估计CV风险预测的鉴别能力。通过使用Hosmer-Lemeshov检验和校准图比较观察到的事件数与预期事件数，评估校准。敏感性和特异性计算的截止值为10%和20%的预测risk.Results的受试者工作特征曲线下面积为0.78-0.80，表明中度至良好的区分患者和无CV事件。CV风险模型系统性冠状动脉风险评估（SCORE）、Fragrance风险评分（FRS）和Reynolds风险评分（RRS）主要低估了低和中等观察到的风险水平下的CV风险，并且大多高估了较高观察到的风险水平下的CV风险。QRisk II主要高估了观察到的CV风险。对于用作CV预防性治疗指标的10%和20%临界值，灵敏度范围分别为68-87%和40- 65%，特异性范围分别为55-76%和77- 88%。根据模型，高达32%的观察到的CV事件发生在RA患者谁被归类为低风险（< 10%）CV diseases.Conclusions建立的风险模型通常低估（系统性冠状动脉风险评估评分，Fragrance风险评分，雷诺风险评分）或高估（QRisk II）RA患者的CV风险。
Objective This study was undertaken to assess the predictive ability of 4 established cardiovascular (CV) risk models for the 10-year risk of fatal and non-fatal CV diseases in European patients with rheumatoid arthritis.Methods Prospectively collected data from the Nijmegen early rheumatoid arthritis (RA) inception cohort was used. Discriminatory ability for CV risk prediction was estimated by the area under the receiver operating characteristic curve. Calibration was assessed by comparing the observed versus expected number of events using Hosmer-Lemeshov tests and calibration plots. Sensitivity and specificity were calculated for the cut-off values of 10% and 20% predicted risk.Results Areas under the receiver operating characteristic curve were 0.78-0.80, indicating moderate to good discrimination between patients with and without a CV event. The CV risk models Systematic Coronary Risk Evaluation (SCORE), Framingham risk score (FRS) and Reynolds risk score (RRS) primarily underestimated CV risk at low and middle observed risk levels, and mostly overestimated CV risk at higher observed risk levels. The QRisk II primarily overestimated observed CV risk. For the 10% and 20% cut-off values used as indicators for CV preventive treatment, sensitivity ranged from 68-87% and 40-65%, respectively and specificity ranged from 55-76% and 77-88%, respectively. Depending on the model, up to 32% of observed CV events occurred in patients with RA who were classified as low risk (< 10%) for CV disease.Conclusions Established risk models generally underestimate (Systematic Coronary Risk Evaluation score, Framingham Risk Score, Reynolds risk score) or overestimate (QRisk II) CV risk in patients with RA.