Evaluation of cardiovascular risk in patients with rheumatoid arthritis. Do cardiovascular biomarkers offer added predictive ability over established clinical risk scores?
Arthritis Care & Research , 04/26/2012
Finckh A et al. – Among the biomarkers tested, only anti–apoA–1 significantly improved the Framingham cardiovascular risk score (FRS) predictive ability. Methods The authors performed an ancillary study derived from a prospective single center cohort including 118 RA patients without cardiovascular 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. Results
During a median follow–up of 9 years, the incidence of CV events was 16%. Both the FRS and 3 of the biomarkers (NT–proBNP, oxLDL, anti–apoA–1) were significant predictors of subsequent CV events (area under the ROC curve (AUC) between 0.68 – 0.73). Anti–apoA–1 was the only biomarkers to improve significantly the FRS's prognostic ability, with AUCs increasing from 0.72 to 0.81 and the IDI improving by 175% (p<0.001).