RMD Open. 2026 Jun 16;12(2):e006847. doi: 10.1136/rmdopen-2026-006847.
ABSTRACT
OBJECTIVES: To evaluate the prognostic value of carotid-femoral pulse wave velocity (cfPWV), a marker of aortic stiffness, for cardiovascular events (CVEs) in patients with autoimmune rheumatic diseases (ARDs) and to compare its performance with the Systematic Coronary Risk Evaluation 2 (SCORE2).
METHODS: This retrospective cohort study included patients with rheumatoid arthritis, systemic sclerosis and spondyloarthritis who underwent clinically indicated baseline non-invasive cfPWV assessment between 2012 and 2017 because of at least one additional cardiovascular risk factor. CV risk was estimated using SCORE2 and SCORE2-OP in eligible patients. Incident CVEs were ascertained through structured interviews over a median 7-year follow-up. Associations were evaluated using Cox proportional hazards models and predictive performance using receiver operating characteristic analysis.
RESULTS: Among 143 patients, 20 CVEs occurred. Baseline cfPWV was higher in patients who developed CVEs versus those who did not (10.06±2.16 m/s vs 8.8±2.3 m/s; p=0.024). SCORE2 did not differ between groups (6.55±3.90% vs 5.61±4.39%, p=0.35). cfPWV demonstrated strong discriminatory capacity for CVEs (area under the curve (AUC) 0.84; 95% CI (0.73 to 0.93), sensitivity 0.87, specificity 0.73), outperforming SCORE2 (AUC 0.56; 95% CI (0.41 to 0.72), sensitivity 0.60, specificity 0.69). In age-adjusted Cox regression, cfPWV remained a significant predictor of CVEs (HR 1.19, 95% CI (1.00 to 1.39); p=0.047). cfPWV correlated with baseline age (p<0.001), mean arterial pressure (p=0.013) and C reactive protein (p=0.011).
DISCUSSION: cfPWV is an independent predictor of future CVEs in patients with ARDs and outperforms SCORE2 in long-term risk prediction. Given its non-invasive nature, cfPWV may provide incremental value for CV risk stratification in this high-risk population.
PMID:42303381 | DOI:10.1136/rmdopen-2026-006847