• Gian Luca Erre, Fabio Cacciapaglia, Garifallia Sakellariou, Andreina Manfredi, Elena Bartoloni, Ombretta Viapiana, Marco Fornaro, Alberto Cauli, Arduino Aleksander Mangoni, Richard John Woodman, Bianca Lucia Palermo, Elisa Gremese, Giacomo Cafaro, Valeria Nucera, Caterina Vacchi, Francesca Romana Spinelli, Fabiola Atzeni, Matteo Piga, and “Cardiovascular, Obesity and Rheumatic Disease Study (CORDIS) Group” of the Italian Society of Rheumatology (SIR).
• University and AOU of Sassari, Dipartimento di Medicina, Chirurgia e Farmacia, Sassari, Italy. Electronic address: glerre@uniss.it.
• Eur. J. Intern. Med. 2022 Oct 1; 104: 49-54.

ObjectivesTo evaluate the association between C-reactive protein (CRP) and 10-year risk of cardiovascular (CV) events using the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), based on conventional and RA-specific risk factors but not CRP, in RA patients without previous cardiovascular events.MethodsERS-RA was calculated in 1,251 "Cardiovascular Obesity and Rheumatic Disease Study (CORDIS)" database patients [(age 60.4(9.3) years; 78% female; disease duration, 11.6(8) years; CDAI, 9(9); CRP, 6.8(12) mg/L].ResultsThe mean (SD) 10-year risk of CV events was 12.9% (10). After adjusting for the use of DMARDs and biologics, CRP concentrations were significantly associated with 10-year risk of CV events (coefficient=0.005 for each 10 mg/L CRP increment; 95%CI 0.000-0.111; p = 0.047). In mediation analysis, the association between CRP and ERS-RA was not explained by disease activity.ConclusionIn a large cohort of RA patients without previous cardiovascular events, a 20 mg/L increase in CRP concentrations was associated with a 1% increase in 10-year risk of CV events. This suggests that actively targeting residual inflammatory risk beyond conventional and RA-specific risk factors might further reduce CV event rates in RA patients.Copyright © 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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