Study: Incorporating SLE, Corticosteroid Use Enables Better Cardiovascular Risk Assessment

A new report has found that a cardiovascular risk calculator that includes the diagnosis of systemic lupus erythematosus (SLE) and corticosteroid use as risk factors does a better job of gauging risk in patients with SLE compared with other prominent models.

The study authors said traditional 10-year risk calculators like the Framingham Risk Score (FRS) and the Atherosclerotic Cardiovascular Disease (ASCVD)calculator work well in the general population. “However, they do not take into account the presence of inflammatory rheumatological diseases such as SLE,” they wrote. “Consequently, their utility in this patient population has been questioned.”

The QRISK3 model, first developed in 2017, was the first to consider SLE and corticosteroid use in its calculation. A British study previously showed it did a better job of predicting the risk of cardiovascular disease among patients with SLE, but until now no such study had been conducted on a population in the United States.

In a new study published in Lupus Science & Medicine, the investigators share the results of a study of 366 adults with SLE. The patients were part of a prospective cohort of subjects who were first recruited as part of an effort to identify biomarkers of atherosclerosis. At the time of enrollment, none of the patients had experienced a cardiovascular event.

The investigators used baseline demographic data, chart information, and diagnoses to assess each patient using the FRS, modified FRS (mFRS), ASCVD, and QRISK3 calculators, as well as the Predictors of Risk for Elevated Flares, Damage Progression and Increased Cardiovascular Disease in Patients with SLE (PREDICTS) risk assessment.

After a 10-year follow-up period, 64 of the patients had experienced at least 1 cardiovascular event, 45% of whom had a QRISK3 score at baseline above 10%. Among those who did not experience a cardiovascular event, 20.5% of patients had a QRISK3 score below 10%.

For patients who did or did not experience a cardiac event, respectively, the authors’ findings show fewer in the latter group had risk scores above 10% for the remaining instruments utilized in the study:

• FRS: 11% vs 7.2%
• mFRS: 40.6% vs 28%
• ASCVD calculator: 12.2% vs and 5.9%
• PREDICTS model: 77% vs 32.1%

“Both QRISK3 and PREDICTS demonstrated better performance compared with ASCVD, FRS, and mFRS in predicting risk of [cardiovascular disease] in this cohort of patients with SLE,” the authors reported.

Yet, they added the caveat that the QRISK3 model is far from perfect, with an area under the receiver operating characteristic curve of just 0.60.

“​​Although QRISK3 takes into account the presence of SLE and active corticosteroid use, it appears that this combination of variables is still neither sufficient nor precise enough to accurately gauge cardiovascular risk in this population,” they added.

One possible solution, they said, would be a combination of QRISK3 and PREDICTS, which they posited may help “find the optimal combination of clinical and biochemical characteristics.”

The authors went on to note that there are no specific guidelines for cardiovascular disease prevention in patients with SLE, a problem that could be addressed if a better risk stratification tool was in place for these patients.

“In summary, the incorporation of SLE and corticosteroid use into the QRISK3 calculator appears to be a step in the right direction toward establishing a more accurate [cardiovascular disease] risk stratification tool for patients with SLE, although further optimisation is needed,” the authors concluded.

Reference

Zhu L, Singh M, Lele S, et al. Assessing the validity of QRISK3 in predicting cardiovascular events in systemic lupus erythematosus. Lupus Sci Med. Published online February 2022. doi:10.1136/lupus-2021-000564