Evaluation of cardiovascular risk in patients with rheumatoid arthritis. Do cardiovascular biomarkers offer added predictive ability over established clinical risk scores?
Arthritis Care & Research , 04/27/2012
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.
- 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).