Recherche 2011

Finckh A, Courvoisier DS, Pagano S, Bas S, Chevallier-Ruggeri P, Hochstrasser D, Roux-Lombard P, Gabay C, Vuilleumier N.

Evaluation of cardiovascular risk in patients with rheumatoid arthritis. Do cardiovascular biomarkers offer added predictive ability over established clinical risk scores?

Arthritis Care Res (Hoboken). 2012 Feb 2. doi: 10.1002/acr.21631. [Epub ahead of print]
Division of Rheumatology, Department of Internal Medicine, Geneva, University Hospitals, Switzerland; Division of Clinical Epidemiology, University of Geneva, School of Medicine, Switzerland.
Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular (CV) disease. CV risk can be estimated using established clinical risk scores; however traditional risk factors do not perform as well in RA patients. Reliable CV risk stratification remains an unmet clinical need in the RA population. It is unknown whether emergent biomarkers increase the predictive ability of clinical scores for CV risk in RA.

To determine whether adding C-reactive protein, anti-citrullinated peptide antibodies, rheumatoid factor, N-terminal pro-Brain Natriuretic peptide (NT-proBNP), oxidized LDL (oxLDL) or anti-apolipoprotein A-1 IgG (anti-apoA-1) to the 10 year-Framingham cardiovascular risk score (FRS) could improve its CV prognostic accuracy in RA.

We 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).

Among the biomarkers tested, only anti-apoA-1 significantly improved the FRS predictive ability. © 2012 by the American College of Rheumatology.