DAS28-γGT for the prediction of major cardiovascular events in rheumatoid arthritis: results from the ESPOIR cohort.

To validate the predictive value of the DAS28-γGT for the occurrence of major cardiovascular (CV) events (MACE) in the ESPOIR cohort. Analysis of 13-year outcome from the ESPOIR cohort. Rheumatoid arthritis (RA) patients with missing data for baseline γGT activity and those not followed-up to 1 year were excluded. Baseline DAS28-γGT was calculated using the following formula: 0.56*√TJ-28 + 0.28*√SJ-28 + 2*ln (γGT)+0.014*GH. Our primary outcome was the merit of the DAS28-γGT in predicting the occurrence of MACE. Among the 696 patients (536 women, mean age of 49 ± 12 years), 34 MACE were recorded, with a mean time to event of 71 ± 44 months. ROC curve analysis indicated that a DAS28-γGT > 9.4 had the best sensitivity and specificity for the diagnosis of MACE during the observation period. DAS28-γGT >9.4 was predictive of the occurrence of MACE, with a hazard ratio (HR) of 3.11 (95% CI 1.41-5.43). Multivariate Cox analyses confirmed higher DAS28-γGT (HR 2.44, 95% CI 1.05-5.64) together with age (HR 1.04, 95% CI 1.01-1.07) and diabetes mellitus (HR 4.12, 95% CI 1.55-10.95) as independent predictors of MACE. There was a dose effect of the DAS28-γGT for MACE-risk prediction, which was in line with the application of the Framingham risk score. The DAS28-γGT was identified in this large prospective cohort as an independent predictor of MACE in patients with RA. The DAS28-γGT is a simple and useful tool to evaluate CV risk in routine and warn the clinician about the CV risk burden in patients with RA.

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