Background/Purpose:

There is a high prevalence of premature atherosclerosis among patients with SLE. The traditional Framingham risk score (FRS) identifies few of the SLE patients who go on to develop coronary artery disease (CAD). This is particularly true among patients aged 30 to 70. It has been suggested that a modified Framingham risk score (mFRS) where each item is multiplied by 2 more accurately identifies patients at Moderate/High risk of CAD, and more accurately predicts subsequent CAD.  Moreover FRS predicts outcomes at 10 years.  In a clinic setting, FRS and mFRS can be assessed more than once over time. The aim of this study was to determine whether the mFRS more accurately identifies patients at higher risk of CAD then FRS when the Risk Scores are assessed repeatedly through time.

Methods:

Patients aged 30 to 70, seen at a large lupus clinic with multiple clinic visits, and in whom all of the variables necessary for the evaluation of FRS and mFRS were available, were included. FRS and mFRS were assessed for each visit and subsequent development of CAD was determined. CAD was defined as presence of myocardial infarction or angina. Descriptive statistics were used to characterize the survey population. Time-dependent covariate proportional hazard models were used to evaluate the Hazard Ratio associated with FRS and with mFRS for the development of future CAD. Adjustments were made in the models for disease activity at each clinic visit using SLEDAI-2K.

Results:

A total of 630 patients were seen for 8098 visits where FRS and mFRS were assessed. 575 (91.3%) were female and their age at SLE diagnosis was 31.4  ± 11.2 years. At first visit in the study, the mean age was 42.4 ± 11.2 with disease duration of 11.1 ± 9.1 years. FRS and mFRS were evaluated for an average of 12.9  ± 9.6 visits per patient. The mean time from study start to the development of CAD or last clinic visit is 12.3 ± 9.7 years. A total of 37 patients went on to develop CAD.

FRS was classified as Moderate/High for 1.2% of all visits and for 16.4% of all visits when using mFRS. 31 (4.9%) patients were classified as Moderate/High at least once in their follow-up compared to 221 (35.1%) for mFRS.

Table 1: Hazard Ratio for the prediction of CAD

Conclusion:

The Modified Framingham Risk Score can better identify patients with Moderate/High risk for CAD. Being applied over multiple visits through time, it better selects patients who are more likely to benefit from more intensive risk factors control.