Hospital Universitari i Politecnic La Fe Valencia, Spain
Ernesto Tovar-Sugrañes, Maria-Carmen Lopez-Gonzalez, Cristina Rodriguez-Alvear, Elisabet Perea-Martinez and Mariano Andrès, Dr Balmis Alicante General University Hospital-ISABIAL, Alicante, Spain
Background/Purpose: Standard cardiovascular (CV) risk assessment tool (SCORE, Framingham Heart Study) performed inaccurately in patients with gout and carotid atheroma plaques (thus, at high CV risk) [PMID 28093417]. An updated version of the European tool (SCORE2), including a calibration for population aged >70 years (SCORE2-OP), has been recently developed. Whether SCORE2 improves the prediction of subclinical atherosclerosis in people with gout remains unknown. We aimed to assess the discriminative value of SCORE2 and SCORE2-OP in detecting carotid atheroma plaques in patients with gout.
Methods: We studied patients with crystal-proven gout enrolled in our inception cohort for structured CV assessment [1], selecting those: a) eligible for SCORE2/SCORE2-OP calculations (absence of established CV disease, diabetes with angiopathy or severe renal disease); and b) with available carotid ultrasound results. SCORE2/SCORE2-OP provides the 10-year risk of fatal and non-fatal CV events, considering traditional risk factors and region of birth. To assess the discriminative value of SCORE2/SCORE2-OP in detecting individuals with carotid plaque, 2×2 tables were built to match high-risk SCORE2 estimations (≥7.5% in < 50years; ≥10% in 50-69years; ≥15% in > 69years) versus the detection of carotid atheroma plaques. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated with their 95% confidence intervals (CI). Afterwards, receiver operating characteristic curves were plotted, allowing an estimation of the area under the curve (AUC).
Results: 193 patients were studied, mainly middle-aged men (mean age 56.8 years, 94.8% male) with a mean of 8.2 years since the first flare and nearly every four patients with subcutaneous tophi. Almost all patients were born in low CV risk regions. Only 32 patients (16.6%) had high-risk SCORE2 scores, while carotid atheroma plaques were detected in 93 patients (48.2%). The results (with 95%CI) for sensitivity, specificity, positive and negative predictive values were 26.9% (17.3-36.4%), 93.0% (87.5-98.5%), 78.1% (62.2-94.0%), 57.8% (49.8-65.7%), respectively. Accordingly, positive and negative likelihood ratios were 3.8 (1.7 to 8.5) and 0.8 (0.7 to 0.9). We estimated an AUC of 0.599 (0.519 to 0.680) for high-RISK SCORE2 scores.
Conclusion: Recently updated SCORE2 is an inaccurate tool to predict the presence of atheroma plaques in patients with gout. Despite new calibrations, the absence of inflammatory and disease-specific variables in risk tools probably limits their discriminative value for gout sufferers.
Disclosures: E. Tovar-Sugrañes, None; M. Lopez-Gonzalez, None; C. Rodriguez-Alvear, None; E. Perea-Martinez, None; M. Andrès, Menarini, Grunenthal.
