Disease Damage Influences Cardiovascular Risk Reclassification Based on Carotid Ultrasound in Patients with Systemic Lupus Erythematosus

Quevedo-Abeledo, Juan Carlos; Rúa-Figueroa, Íñigo; Sánchez-Pérez, Hiurma; Tejera-Segura, Beatriz; Vera-González, Antonia de; González-Delgado, Alejandra; Llorca, Javier; Ferraz-Amaro, Iván

doi:10.3899/jrheum.180881

Cited by 14 publications

(9 citation statements)

References 36 publications

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“…For this reason, this calculator could better predict subclinical atherosclerosis in patients with IBD. Our data confirm previous results reported in other inflammatory diseases such as rheumatoid arthritis [ 13 ], spondyloarthropathies [ 14 ], or systemic lupus erythematosus [ 15 ]. We believe that the inflammatory load present in patients with IBD may also be responsible for this discrepancy between scores in patients and controls.…”

Section: Discussionsupporting

confidence: 92%

QRISK3 Performance in the Assessment of Cardiovascular Risk in Patients with Inflammatory Bowel Disease

Carrillo-Palau

Hernández-Camba

Ramos

et al. 2021

JCM

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Inflammatory bowel disease (IBD) has been described as an independent risk factor for the development of cardiovascular (CV) disease. Since the QRESEARCH risk estimator version 3 (QRISK3) calculator was recently proposed to assess CV in the general population, our objective was to compare the predictive ability of QRISK3 with that of a well-established European CV risk calculator, the Systematic Coronary Risk Assessment (SCORE), to identify the presence of subclinical carotid atherosclerosis in patients with IBD. In all, 186 patients with IBD and 178 controls were recruited. The presence of subclinical atherosclerosis was evaluated by carotid ultrasound to identify carotid plaque and the thickness of the carotid intima-media (cIMT). QRISK3 and SCORE were calculated. The relationship of QRISK3 and SCORE with each other and with the presence of subclinical carotid atherosclerosis (both carotid plaque and cIMT) was studied in patients and controls. SCORE (0.2 (interquartile range 0.1–0.9) vs. 0.4 (0.1–1.4), p = 0.55) and QRISK3 1.7 ((0.6–4.6) vs. 3.0 (1.0–7.8), p = 0.16) absolute values did not differ between patients and controls. QRISK3 and SCORE correlated equally with cIMT within both populations. However, SCORE correlation with cIMT was found to be significantly lower in patients with IBD when compared to controls (Spearman’s Rho 0.715 vs. 0.587, p = 0.034). Discrimination analysis of both calculators with carotid plaque was similar within both populations. Nevertheless, in patients with IBD, QRISK3 showed a trend toward a higher discrimination (QRISK3 area under the curve 0.812 (95%CI 0.748–0.875) vs. SCORE 0.790 (95%CI 0.723–0.856), p = 0.051). In conclusion, QRISK3 discrimination for subclinical atherosclerosis is optimal and equivalent to that of SCORE in IBD patients. However, our findings highlight the role of QRISK3 as an appropriate tool for the assessment of CV risk in patients with IBD.

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Section: Discussionsupporting

confidence: 92%

QRISK3 Performance in the Assessment of Cardiovascular Risk in Patients with Inflammatory Bowel Disease

Carrillo-Palau

Hernández-Camba

Ramos

et al. 2021

JCM

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“…It has been reported that the addition of cIMT measurement and presence of carotid plaque to the Framingham risk score improves net reclassification index for predicting CV events in the general population 45. In the cross-sectional study in patients with SLE, only 6% of patients fulfilled the definitions for high or very high risk according to the SCORE risk algorithms, but as many as 32% of patients were reclassified into a very high-risk category after ultrasound assessment 46…”

Section: Discussionmentioning

confidence: 99%

Similar progression of carotid intima–media thickness in 7-year surveillance of patients with mild SLE and controls, but this progression is still promoted by dyslipidaemia, lower HDL levels, hypertension, history of lupus nephritis and a higher prednisolone usage in patients

et al. 2020

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ObjectiveTo compare progression of subclinical atherosclerosis and factors promoting it in patients with SLE and controls.MethodsConsecutive patients with SLE and age-matched, sex-matched population controls from the SLEVIC cohort were assessed at inclusion and after 7 years with standardised data collection and carotid ultrasound. Effect of risk factors on carotid intima–media thickness (cIMT) progression was examined with adjusted linear mixed models.ResultsA total of 77 patients and 74 controls, 68% and 61% of the original cohort, completed follow-up. The patients were (mean) 47 years old, 90% were women, and controls were 51 years old, 92% women. Patients had disease duration of (mean) 11 years, mild disease activity and low severity at both assessments. Baseline cIMT did not differ between the groups. An average absolute cIMT progression was 0.009 mm/year in patients and 0.011 mm/year in controls, intergroup difference p=0.9.Of factors at inclusion, dyslipidaemia, lower levels of high-density lipoprotein (HDL) and carotid plaque in patients and controls, and higher systolic blood pressure, total cholesterol:HDL and LDL:HDL ratios and triglycerides in patients were associated with cIMT progression. Of factors at follow-up, hypertension and blood lipids in patients and HDL in controls were significantly associated with cIMT progression. History of lupus nephritis and a higher average dose of prednisolone used since diagnosis were associated with cIMT progression in patients. Associations of risk factors with cIMT progression were stronger in presence of plaques.ConclusionWe observed a statistically comparable progression of cIMT in patients with mild SLE and controls over 7 years, which implies that progression of subclinical atherosclerosis in some patients with SLE could follow that of the general population. Traditional cardiovascular (CV) risk factors, history of lupus nephritis and higher use of corticosteroids promote cIMT progression in SLE. Detection of carotid plaque may add to CV risk stratification.

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“…In this case, reclassification was independently explained by the disease activity. Likewise, in a cross-sectional study that included 276 patients with systemic lupus erythematosus, following carotid ultrasound assessment, 32% of the patients were reclassified as very high-risk category [27]. In these SLE patients, disease duration and damage were independently associated with a higher risk of reclassification.…”

Section: Discussionmentioning

confidence: 99%

Disease activity influences the reclassification of rheumatoid arthritis into very high cardiovascular risk

et al. 2021

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Background Previous studies have shown that risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the actual cardiovascular (CV) risk of patients with rheumatoid arthritis (RA). In contrast, carotid ultrasound was found to be useful to identify RA patients at high CV. In the present study, we aimed to determine if specific disease features influence the CV risk reclassification of RA patients assessed by SCORE risk charts and carotid ultrasound. Methods 1279 RA patients without previous CV events, diabetes, or chronic kidney disease were studied. Disease characteristics including disease activity scores, CV comorbidity, SCORE calculation, and the presence of carotid plaque by carotid ultrasound were assessed. A multivariable regression analysis was performed to evaluate if the reclassification into very high CV risk category was independently associated with specific features of the disease including disease activity. Additionally, a prediction model for reclassification was constructed in RA patients. Results After carotid ultrasound assessments, 54% of the patients had carotid plaque and consequently fulfilled definition for very high CV risk. Disease activity was statistically significantly associated with reclassification after fully multivariable analysis. A predictive model containing the presence of dyslipidemia and hypertension, an age exceeding 54 years, and a DAS28-ESR score equal or higher than 2.6 yielded the highest discrimination for reclassification. Conclusion Reclassification into very high CV risk after carotid ultrasound assessment occurs in more than the half of patients with RA. This reclassification can be independently explained by the activity of the disease.

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Disease Damage Influences Cardiovascular Risk Reclassification Based on Carotid Ultrasound in Patients with Systemic Lupus Erythematosus

Cited by 14 publications

References 36 publications

QRISK3 Performance in the Assessment of Cardiovascular Risk in Patients with Inflammatory Bowel Disease

QRISK3 Performance in the Assessment of Cardiovascular Risk in Patients with Inflammatory Bowel Disease

Similar progression of carotid intima–media thickness in 7-year surveillance of patients with mild SLE and controls, but this progression is still promoted by dyslipidaemia, lower HDL levels, hypertension, history of lupus nephritis and a higher prednisolone usage in patients

Disease activity influences the reclassification of rheumatoid arthritis into very high cardiovascular risk

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