Individuals with chronic inflammatory rheumatic diseases (CIRD) have an elevated risk of cardiovascular (CV) complications, which remain the leading cause of mortality in this population. This increased risk is partly attributed to inflammatory mechanisms that drive the development and progression of CV disease (CVD) [1]. Additionally, traditional CV risk factors and genetic predisposition also contribute to the heightened risk of CVD in these patients [2].

The European Society of Cardiology developed the Systematic COronary Risk Evaluation (SCORE) scale in 2003 as a tool to estimate the 10-year risk CVD-related death [3]. Subsequently, the European Alliance of Associations for Rheumatology (EULAR) recommended an adaptation of the SCORE for patients with CIRD. This modified version, known as the EULAR-modified SCORE, multiplies the original SCORE by a factor of 1.5 and is applied in both high- and low-CV-risk countries [4,5].

Over time, new CV risk assessment scales have been developed, shifting the focus from predicting CV mortality to estimating the overall incidence of CV events. For example, the SCORE2 scale, introduced in 2021, estimates the 10-year risk of both fatal and non-fatal CV events in individuals without prior CVD or diabetes across Europe [6]. Similarly, the QRESEARCH risk estimator (QRISK) series—QRISK, QRISK2, and QRISK3—was developed to estimate 10-year CV risk specifically in England [7]. In this regard, in previous studies, we have highlighted differences in the performance of QRISK3 and SCORE2 among patients with psoriatic arthritis and ankylosing spondylitis [[8], [9], [10]].

In 2023, the American Heart Association introduced the Predicting Risk of CVD EVENTs (PREVENT) scale, designed to estimate 10-year CV risk [11]. However, this scale has generated some controversy, as its risk estimates tend to be lower than those of earlier models. This could potentially reduce the proportion of individuals classified as having high CV risk and, consequently, decrease the number of people eligible for primary prevention with statins [12].

Due to the increased risk of CVD observed in patients with CIRD, it is essential for clinicians managing these patients to have updated recommendations for CV risk assessment. Therefore, in the present study, we compare the performance of QRISK3, SCORE2, and PREVENT in a cohort of approximately 2000 individuals with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis, enrolled in the Spanish prospective CARdiovascular in RheuMAtology (CARMA) project and followed over a 10-year period [13]. We excluded the original SCORE and its EULAR modification from this analysis, as they are designed to estimate CV mortality risk rather than the combined risk of fatal and non-fatal CV events.