Arterial Stiffness Measure Outperforms Standard CV Risk Score in Autoimmune Rheumatic Diseases: Study
A study involving patients with rheumatoid arthritis (RA), systemic sclerosis, and spondyloarthritis has found that carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, predicted future cardiovascular (CV) events more accurately than the commonly used SCORE2 risk assessment system. Patients with autoimmune rheumatic diseases are known to have an increased risk of cardiovascular complications, but traditional risk calculators often underestimate this risk. In this study, cfPWV proved to be a superior tool for identifying patients at higher risk of future CV events, suggesting that arterial stiffness assessment may improve cardiovascular risk stratification in this population. The study was published in the Rheumatic and Musculoskeletal Diseases journal by Konstantinos T. and colleagues.
This study included patients diagnosed with major autoimmune rheumatic disorders such as rheumatoid arthritis, systemic sclerosis, and spondyloarthritis that have previously received a clinically indicated cfPWV measurement between 2012 and 2017 because they had at least another traditional risk factor for cardiovascular disease. Cardiovascular risk was formally calculated using the standard SCORE2 and SCORE2 Older Person (SCORE2-OP) calculations for each patient. The occurrence of CVE, including myocardial infarction and stroke and any other vascular complications, was assessed through systematic clinical interviews over the course of 7 years of follow-up. Age-adjusted Cox proportional hazards regression models were used for mapping statistical correlations and the overall discrimination ability of each method was assessed by means of ROC curves.
Key findings:
- Indeed, the retrospective cohort study effectively followed up, assessed and analyzed an aggregate sample of 143 patients with high-risk autoimmune rheumatic diseases.
- During the extensive 7 years follow-up, there were totally 20 cases of confirmed incident cardiovascular events within the followed-up cohort. cfPWV was significantly higher in the subgroup of patients with subsequent occurrence of cardiovascular disease than in patients without cardiovascular event, which was 10.06 ± 2.16 m/s vs. 8.8 ± 2.3 m/s (p = 0.024).
- On the contrary to the results of vascular assessment, there was no statistically significant difference in baseline SCORE2 calculation between the two subgroups with values of 6.55% ± 3.90% vs. 5.61% ± 4.39% (p = 0.35).
- The non-invasive cfPWV marker showed extremely high discriminatory power for prediction of future events, with AUC equal to 0.84 (95% CI, 0.73 to 0.93), high sensitivity to 0.87, and specificity to 0.73.
- The standard SCORE2 scoring system was significantly ineffective in this population, with AUC equal to only 0.56 (95% CI, 0.41 to 0.72), sensitivity to 0.60, and specificity to 0.69.
- In fully age-adjusted Cox regression modeling, each unit increase in baseline cfPWV remained a strong independent predictor of future cardiac events, demonstrating a hazard ratio of 1.19 (95% CI, 1.00 to 1.39; p = 0.047).
- The baseline pulse wave velocity measurements correlated directly with increasing patient age (p < 0.001), higher mean arterial pressure (p = 0.013), and elevated levels of systemic C-reactive protein (p = 0.011).
In summary, cfPWV serves as an independent predictor of future CVEs among patients with ARDs and is superior to SCORE2 for predicting long-term outcomes. Considering the non-invasiveness of the method, it may be useful for assessing the CV risk in this high-risk group of people. This retrospective cohort study constitutes a key empirical basis for cardio-rheumatology in the present times, confirming the possibility of advanced risk profiling using tissue stiffness measurement.
Reference:
Triantafyllias, K., Aldabbag, M., Schepers, M., Geber, C., Fanouriakis, A., Muthuraman, M., Dürük, S. G., & Schwarting, A. (2026). Carotid-femoral pulse wave velocity improves cardiovascular risk prediction beyond SCORE2 in autoimmune rheumatic diseases: a 7-year follow-up study. RMD Open, 12(2), e006847. https://doi.org/10.1136/rmdopen-2026-006847
