Assessment of cardiovascular risk tools as predictors of cardiovascular disease events in systemic lupus erythematosus

Abstract

BackgroundSLE is an independent risk factor for cardiovascular disease (CVD). This study aimed to determine which among QRISK2, QRISK3, Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS) and SLE Cardiovascular Risk Equation (SLECRE) best predicts CVD.MethodsThis is a single-centre analysis on 1887 patients with SLE followed prospectively according to a standard protocol. Tools’ scores were evaluated against CVD development at/within 10 years for patients with CVD and without CVD. For patients with CVD, the index date for risk score calculation was chosen as close to 10 years prior to CVD event. For patients without CVD, risk scores were calculated as close to 10 years prior to the most recent clinic appointment. Proportions of low-risk (<10%), intermediate-risk (10%–20%) and high-risk (>20%) patients for developing CVD according to each tool were determined, allowing sensitivity, specificity, positive/negative predictive value and concordance (c) statistics analysis.ResultsAmong 1887 patients, 232 CVD events occurred. QRISK2 and FRS, and QRISK3 and mFRS, performed similarly. SLECRE classified the highest number of patients as intermediate and high risk. Sensitivities and specificities were 19% and 93% for QRISK2, 22% and 93% for FRS, 46% and 83% for mFRS, 47% and 78% for QRISK3, and 61% and 64% for SLECRE. Tools were similar in negative predictive value, ranging from 89% (QRISK2) to 92% (SLECRE). FRS and mFRS had the greatest c-statistics (0.73), while QRISK3 and SLECRE had the lowest (0. 67).ConclusionmFRS was superior to FRS and was not outperformed by the QRISK tools. SLECRE had the highest sensitivity but the lowest specificity. mFRS is an SLE-adjusted practical tool with a simple, intuitive scoring system reasonably appropriate for ambulatory settings, with more research needed to develop more accurate CVD risk prediction tools in this population.

Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps—A Rapid Scoping Review

“…The incorporation of SLE and the use of corticosteroids in risk scores seems to be a step in the right direction to establish a more accurate cardiovascular risk stratification tool for patients with SLE, although further optimization, standardization, and simplification are needed for use in daily practice [ 6 , 13 , 14 , 26 , 27 ].…”

“…The evidence of the burden of these health problems in SLE patients is shaped by the methods used to assess them. In this regard, several approaches have emerged in recent years, ranging from molecular to imaging methods, including equations and indexes which do not always perform adequately or are useful in clinical practice [ 12 , 13 , 14 ]. The lack of consensus and the great heterogeneity in the way assessment methods are applied and interpreted has consolidated obesity, diabetes mellitus, and cardiovascular risk as a real challenge for SLE research and clinical practice [ 12 , 15 ].…”

SCORE2 versus SCORE in patients with systemic lupus erythematosus

“…It was concluded none of the scores achieve robust sensitivity, specificity, or accuracy in these population. 19 The chronic inflammation that accompanies the disease, the accelerated atherosclerosis process, the presence of inflammatory dyslipidemia, 20 and the alteration of glucose homeostasis metabolism 21 that these patients present are all responsible for this poor performance. According to our results, SCORE2, and not SCORE, is the better choice for CV risk assessment in patients with SLE.…”

Sudden Death in a Young Male Patient: When Lupus and Cardiovascular Disease Intersect

“…15,16,21 As a result, stratification tools such as Framingham Risk Score underestimates cardiovascular risk in this population. 22,23…”