Dr. Gabay has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Roche, Abbott, Pfizer, and MSD.
Evaluation of cardiovascular risk in patients with rheumatoid arthritis: Do cardiovascular biomarkers offer added predictive ability over established clinical risk scores?
Article first published online: 25 MAY 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 6, pages 817–825, June 2012
How to Cite
Finckh, A., Courvoisier, D. S., Pagano, S., Bas, S., Chevallier-Ruggeri, P., Hochstrasser, D., Roux-Lombard, P., Gabay, C. and Vuilleumier, N. (2012), Evaluation of cardiovascular risk in patients with rheumatoid arthritis: Do cardiovascular biomarkers offer added predictive ability over established clinical risk scores?. Arthritis Care Res, 64: 817–825. doi: 10.1002/acr.21631
- Issue published online: 3 MAY 2012
- Article first published online: 25 MAY 2012
- Accepted manuscript online: 2 FEB 2012 10:12AM EST
- Manuscript Accepted: 30 JAN 2012
- Manuscript Received: 10 OCT 2011
- Swiss National Science Foundation. Grant Number: 3200B0_120639/1
- Lucie et Ernst Schmidheiny foundation
- Swiss National Science Foundation. Grant Number: 310030-135195
- Telemaque and Gustave et Simone Prevot foundations
To determine whether adding C-reactive protein, anti–cyclic citrullinated peptide antibodies, rheumatoid factor, N-terminal pro–brain natriuretic peptide (NT-proBNP), oxidized low-density lipoprotein (ox-LDL), or anti–apolipoprotein A-I (anti–Apo A-I) IgG to the Framingham 10-year cardiovascular (CV) risk score (FRS) could improve its CV prognostic accuracy in rheumatoid arthritis (RA).
We performed an ancillary study derived from a prospective single-center cohort consisting of 118 RA patients without CV disease at baseline. The FRS and the various biomarkers were assessed at enrollment and their prognostic accuracy was determined using receiver operating characteristic (ROC) curve analysis. The incremental predictive ability of biomarkers was assessed using the integrated discrimination improvement (IDI) statistics.
During a median followup period of 9 years, the incidence of CV events was 16%. Both the FRS and 3 of the biomarkers (NT-proBNP, ox-LDL, and anti–Apo A-I) were significant predictors of subsequent CV events (area under the ROC curve [AUC] between 0.68 and 0.73). Anti–Apo A-I was the only biomarker to significantly improve the prognostic ability of the FRS, with AUCs increasing from 0.72 to 0.81 and the IDI improving by 175% (P < 0.001).
Among the biomarkers tested, only anti–Apo A-I significantly improved the FRS predictive ability.