Background: Patients with rheumatic diseases (RD) have a higher risk of cardiovascular events (CVE), as inflammation itself is a cardiovascular (CV) risk factor [1]. Remission of RD is also of utmost importance for this reason. Scoring systems such as SCORE (Systemic COronary Risk Evaluation) [2] attempt to calculate a 10-year risk of CVE. Although SCORE takes into account the presence of RD, it is not clear whether the calculated score corresponds to the actual risk over 10 years, especially with regard to different subtypes of RD. Furthermore, anti-inflammatory therapy has improved. SCORE has also been adjusted to SCORE2 [3].

Objectives: Our aim was to compare the SCORE-based estimated and actual incidence of CVE in an RD population after 10 years, taking into account previously published data from a 5-year follow-up (FU I) [4].

Methods: Based on an inception cohort from 2005 with 764 patients with RD, we performed a long-term follow up (FU) to compare the initial assessment of CV-risk and the frequency and timing of CVE occurrence. The analysis was based on questionnaires and an interview. CVE were defined as unstable angina pectoris, myocardial infarction, coronary revascularization, hospitalization due to heart failure, stroke, resuscitation and regular shock delivery with cardiac defibrillator. Patients were categorized into 3 groups according to the underlying RD: Rheumatoid arthritis (RA), spondyloarthritis (SpA) and systemic autoimmune diseases (SAD; i.e. connective tissue diseases and vasculitides). SCORE contains the risk for fatal CVE for individuals aged 40-69 years in Europe based on gender, age, smoking status, systolic blood pressure (mmHg), total cholesterol (mmol/L) or cholesterol/HDL-ratio. In the updated version (SCORE2), non-fatal events are now also considered. SCORE baseline value was compared with the actual frequency of CVE after ≥ 10 years. In addition, SCORE2 was calculated retrospectively for the original cohort and compared with the SCORE. The CVEs were calculated in total and for each subgroup.

Results: Out of 764 patients who were included into the study (mean age 51.4±14.5 years; RA: N= 352, SAD: N=260, SpA: N=152), n=309 (40.4 %) patients participated in the current FU (mean age 63.1±11.1 years; mean FU time 16.6± 1.09 years; RA: N=141, SAD: N=104, SpA: N=64). N=124 (16.2%) patients had died during the observation period (19/124 cardiac death; 53/124 non-cardiac death; 52/124 unknown cause of death). 331 (43.3%) patients were excluded from the current analysis (no informed consent or unavailable). In 149 (19.5%) of these patients, we had no information on whether they had a CVE or whether they died. Overall, we had information on whether cardiac death had occurred in 381/764 (49.9%) patients.

In addition to 38/764 (5%) patients who had a CVE up to FU I, 29/309 (9.4%) had a CVE after 10 years, 19/563 (3.4%) suffered a cardiac death. The mean time to a first CVE was 7.17±6.01 years. Patients with RA had the highest rate of CVE excluding cardiac death (RA: 9.4%; SpA: 3.9%; SAD: 8.8%). Regarding cardiac deaths, the highest rate was seen in patients with SAD (12.3%; RA: 11.7%; SpA: 3.9%). Mean overall-SCORE was 1.8%±2.5% with the highest subgroup-mean in SAD (2.1%±2.9%). Using SCORE2 overall-mean was 1.3%±1.9%. Again SAD had the highest mean of the 3 subgroups (1.5±2.3%).

Conclusion: CV-risk is relevant for patients with RD. Due to the chronic nature of the inflammation in particular, a long-term assessment is required. Scoring systems such as SCORE/SCORE2 can be helpful to estimate CV-risk.

REFERENCES: [1] Lüscher, T.F., Inflammation: the new cardiovascular risk factor. European Heart Journal, 2018. 39 (38): p. 3483-3487.

[2] Conroy, R.M., et al., Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. European Heart Journal, 2003. 24 (11): p. 987-1003.

[3] group, S.w. and E.C.r. collaboration, SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. European Heart Journal, 2021. 42 (25): p. 2439-2454.

[4] Breunig, M., et al., Simple screening tools predict death and cardiovascular events in patients with rheumatic disease. Scand J Rheumatol, 2018. 47 (2): p. 102-109.

Acknowledgements: NIL.

Disclosure of Interests: Matthias Fröhlich: None declared, Marc Schmalzing BMS, Novartis, AbbVie, AstraZeneca, Chugai/Roche, Janssen-Cilag, Gilead,

Boehringer/Ingelheim, Mylan, onkowissen.de, Galapagos, EUSA-Pharma, Chugai/Roche, Hexal/Sandoz, Gilead, AbbVie, Janssen-Cilag, Boehringer/Ingelheim,

onkowissen.de, EUSA-Pharma, Novartis, AstraZeneca, Amgen, medac, Lilly, Galapagos, UCB, Chugai, Novartis, Stefan Stoerk: None declared, Michael Gernert: None declared, Hanna Purucker: None declared, Stefan Kleinert: None declared, Margret Breunig: None declared, Patrick P. Strunz: None declared, Hannah Labinsky: None declared, Peter U. Heuschmann: None declared, Viktoria Rücker: None declared, Caroline Morbach: None declared.