Difficult to predict cardiovascular risk in rheumatoid arthritis

Both established and new disease-specific risk calculators fail to predict cardiovascular disease in patients with rheumatoid arthritis better than calculators designed for the general population, Cynthia Sue Crowson‘s research shows.


  1. Four established risk calculators for patients with rheumatoid arthritis did not predict risk of cardiovascular disease more accurately than risk calculators meant for the general population.
  2. Neither of two newly developed models to estimate cardiovascular risk were better than risk calculators designed for use in the general population.
  3. 30 % of cardiovacular events in rheumatoid arthritis are attributable to the rheumatic disease. 49 % are attributable to traditional cardiovascular risk factors.


Thesis: The Complexities of Accurately Assessing Cardiovascular Disease Risk among Patients with Rheumatoid Arthritis
Candidate: Cynthia Sue Crowson
Time: November 30, 2017 at 13:15
Place: Diakonhjemmet University College, Oslo: Lower Auditorium
Link to university website (in Norwegian)


(1) Several cardiovascular risk calculators have been established and are recommended for use in patients with rheumatoid arthritis, because the calculators meant for the general population are inaccurate. However, none of the four disease-specific calculators Crowson and co-workers tried to validate in this study proved better than other risk calculators. In the study, 100 out of almost 1800 included patients with rheumatoid arthritis developed cardiovascular disease within seven years of follow-up.

(2) The group tried to make a calculator to improve risk prediction, including data from 5638 patients from ten countries. Two models were developed, based on patient age, gender, smoking, blood pressure and cholesterol profile, in addition to either rheumatoid arthritis activity or self-reported health. Neither of them proved better than calculators designed for the general population. In the article, Crowson and co-workers discuss challenges in developing an accurate tool to calculate risk of cardiovascular disease in this group of patients.

(3) Smoking and hypertension are the most important contributors to cardiovascular disease in patients with rheumatoid arthritis. Elevated total cholesterol and active rheumatic disease also contribute greatly. This study also includes 5638 patients, and analyses the impact of both traditional cardiovascular risk factors and factors related to the rheumatoid arthritis. Overall, 30 % of the cardiovascular events during follow-up could be attributed to the rheumatoid arthritis, whereas half could be explained by traditional cardiovascular risk factors.


(1) Crowson, C. S., Gabriel, S. E., Semb, A. G., van Riel, P. L., Karpouzas, G., Dessein, P. H., Hitchon, C., Pascual-Ramos, V., Kitas, G. D., & Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis. (2017). Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countriesRheumatology56(7), 1102-1110.

(2) Crowson, C. S., Rollefstad, S., Kitas, G. D., Van Riel, P. L., Gabriel, S. E., & Semb, A. G. (2017). Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritisPloS one12(3), e0174656.

(3) Crowson, C. S., Rollefstad, S., Ikdahl, E., Kitas, G. D., van Riel, P. L., Gabriel, S. E., Matteson, E. L., Kvien, T. K., Douglas, K., Sandoo, A., Arts, E., Wållberg-Jonsson, S., Innala, L., Karpouzas, G., Dessein, P. H., Tsang, L., El-Gabalawy, H., Hitchon, C., Ramos, V. P., Yáñes, I. C., Sfikakis, P. P., Zampeli, E., Gonzalez-Gay, M. A., Corrales, A., van der Laar, M., Vonkeman, H. E., Meek, I., & Semb, A. G. (2017). Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritisAnnals of the Rheumatic Diseases, annrheumdis-2017.