A SIMPLE, non-invasive measure of artery stiffness predicted heart attacks and strokes far better than the widely used SCORE2 algorithm in patients with autoimmune rheumatic diseases, a seven-year study found, flagging high-risk patients that standard tools missed.
Cardiovascular Risk Assessment in Autoimmune Rheumatic Diseases
Patients with autoimmune rheumatic diseases (ARDs) face substantially raised cardiovascular risk, yet standard calculators capture it poorly. Tools like SCORE2 rest on traditional risk factors and overlook disease-specific drivers such as chronic inflammation and inflammation-led vascular damage. Carotid-femoral pulse wave velocity (cfPWV), a marker of aortic stiffness, offered a possible alternative.
Study Design and Risk Assessment Methods
The retrospective cohort study followed 143 patients with rheumatoid arthritis, systemic sclerosis, or spondyloarthritis, each with at least one additional cardiovascular risk factor, who had clinically indicated baseline cfPWV measured between 2012 and 2017. Cardiovascular risk was also estimated using SCORE2 and SCORE2-OP. Incident cardiovascular events were ascertained through structured interviews over a median seven-year follow-up.
Predictive Performance Versus SCORE2
Among the 143 patients, 20 cardiovascular events occurred. Baseline cfPWV was higher in those who later had an event than in those who did not (10.06 vs 8.8 m/s; p=0.024), whereas SCORE2 did not differ between groups (6.55% vs 5.61%; p=0.35). cfPWV showed strong discrimination for events (AUC 0.84; 95% CI 0.73 to 0.93; sensitivity 0.87, specificity 0.73), clearly outperforming SCORE2 (AUC 0.56; 95% CI 0.41 to 0.72). In age-adjusted Cox regression, cfPWV remained an independent predictor (hazard ratio 1.19; 95% CI 1.00 to 1.39; p=0.047). It also correlated with age (p<0.001), mean arterial pressure (p=0.013), and C-reactive protein (p=0.011).
Implications for Cardiovascular Risk Stratification
The authors concluded that cfPWV is an independent predictor of future cardiovascular events in autoimmune rheumatic diseases and outperforms SCORE2 over the long term. Being non-invasive, it could add value to risk stratification, helping identify high-risk patients whom traditional scores miss and supporting earlier, more individualised prevention. They cautioned that the single-centre cohort was small with relatively few events, so larger studies are needed before cfPWV could be embedded in routine practice or guidelines.
Reference
Triantafyllias K et al. Carotid-femoral pulse wave velocity improves cardiovascular risk prediction beyond SCORE2 in autoimmune rheumatic diseases: a 7-year follow-up study. RMD Open. 2026;12:e006847.
Featured image: Khan on Adobe Stock
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