SCORE2 is superior to SCORE in predicting the presence of carotid plaques and intima-media thickness in rheumatoid arthritis patients: a cross-sectional study using carotid ultrasound

Abstract

Background: Rheumatoid arthritis (RA) increases the risk of premature mortality, primarily due to cardiovascular diseases (CVD). While Systematic Coronary Risk Evaluation (SCORE) and its updated version SCORE2 are used to estimate CVD risk, these tools may not adequately capture the full cardiovascular risk profile in RA patients. Objectives: This study aims to compare the effectiveness of SCORE2 versus SCORE in predicting the presence of carotid plaques or increased intima-media thickness (IMT), as detected by ultrasound, in RA patients. Design: This was a single-center cross-sectional study and included adult RA patients with moderate to severe disease who initiated treatment with Janus kinase inhibitors or anti-tumor necrosis factor inhibitors between September 2022 and April 2023. Methods: Both SCORE and SCORE2 were calculated for each patient. Carotid ultrasound examinations documented the presence of plaques, and IMT was measured. Results: A total of 122 patients were included. The mean SCORE was 2.48%, while SCORE2 was significantly higher at 4.07% ( p < 0.01). SCORE identified 12 (10%) patients as high risk, while SCORE2 identified 99 (81%). Atherosclerotic plaques were present in 34% ( n = 42) of participants. Traditional cardiovascular risk factors (dyslipidemia, diabetes, hypertension, and smoking) were significantly associated with ultrasound-detected risk. In 87 cases where SCORE was underestimated, 34 patients (39%) classified as low–moderate risk by SCORE were correctly reclassified as high risk by SCORE2. However, 54 cases classified as high risk by SCORE2 had normal carotid ultrasounds. The sensitivity of SCORE for predicting plaque presence was 21%, compared to 100% for SCORE2. Combining SCORE with carotid ultrasound increased the detection of high-risk patients from 10% to 38%. However, adding carotid ultrasound to SCORE2 did not increase the detection rate beyond 81%. Conclusion: Our findings highlight the superior performance of SCORE2 compared to SCORE in identifying RA patients with carotid ultrasound abnormalities, thus indicating a higher cardiovascular risk.