Session Information
Date: Sunday, November 8, 2015
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
B
Background/Purpose: In 2013 the American College of Cardiology (ACC) and the American Heart Association (AHA) developed a new formula to estimate the 10-year risk of an adverse cardiovascular event based on traditional cardiovascular risk factors. In contrast to previous formulae, this new formula focused on risk of “hard“ events of myocardial infarction or stroke. Using a large cohort of patients with SLE, we derived a formula for estimating the 10-year risk of hard cardiovascular events (CVE) among patients with SLE based on both traditional and SLE-related risk factors, and compared our findings to the ACC/AHA risk estimates.
Methods: This analysis is based on data from the Hopkins Lupus Cohort since 1987. A CVE was defined as the first occurrence of a stroke or myocardial infarction (MI). Patients who had a CVE prior to cohort entry or within the first two years of cohort participation were exluded from the analysis. There were 1513 patients included, 92% female, 54% Caucasian, 39% African-American, median age at baseline was 35 and median duration of follow-up was 8 years. To derive the score, risk factors were calculated based on variables measured in the first two years of cohort participation. Cox Proportional Hazards models were constructed to determine the variables that affected the risk of a subsequent CVE. Using the results, a formula to calculate the risk of a CVE within the next 10 years was derived.
Results: 100 CVE were observed: 63 strokes, 36 MI, and 1 diagnosed with both stroke and MI. Table 1 shows the results of a multivariable Cox model used to estimate 10 year risk.
Table 1: Association between predictors and risk of a CVD event among patients with SLE.
|
|
Hazard Ratio (95% CI) |
P-value |
|
Age (per decade) |
1.3 (1.1, 1.5) |
0.0050 |
|
Male (vs. female) |
1.5 (0.8, 2.8) |
0.17 |
|
Systolic Blood Pressure (per 10 mmHg)1 |
1.3 (1.1, 1.6) |
0.0010 |
|
Cholesterol (per 25 mg/dl)1 |
1.1 (1.0, 1.2) |
0.11 |
|
Current Smoking |
1.6 (1.0, 2.6) |
0.055 |
|
Diabetes |
1.5 (0,9, 2.6) |
0.12 |
|
SLEDAI (per unit increase)1 |
1.1 (1.0, 1.2) |
0.028 |
|
History of Lupus Anticoagulant |
2.2 (1.4, 3.3) |
0.0003 |
|
Low Mean C31 |
1.8 (1.1, 2.9) |
0.027 |
1 Based on mean during the first two years of cohort participation.
Table 2 shows how the estimated 10-year risk for CVE based on this model compares to the risk from the ACC/AHA risk assessment tool for selected subgroups.
Table 2: Estimated 10-year risk based on our formula, and the ACC/AHA formula for selected subgroups.
|
Risk Profile |
Estimated 10-year risk based on our formula |
Estimated 10-year risk based on 2013 ACC/AHA score1 |
|
White Woman, age 40, SBP=120 (treated), Chol=150, HDL=40, No other risk factors |
2.6% |
0.7% |
|
White Woman, age 60, SBP=120 (treated), Chol=150, HDL=40, No other risk factors |
4.2% |
3.9% |
|
White Woman, age 60, SBP=120 (treated), Chol=150, HDL=40, Mean SLEDAI=3, No other risk factors |
6.9% |
3.9% |
|
White Woman, age 60, SBP=120 (treated), Chol=150, HDL=40, Low C3, No other risk factors |
7.4% |
3.9% |
|
White Woman, age 60, SBP=120 (treated), Chol=150, HDL=40, Hx of Lupus Anticoagulant, No other risk factors |
9.1% |
3.9% |
1 Calculated at http://tools.cardiosource.org/ASCVD-Risk-Estimator/
Conclusion: Patients with SLE are generally at increased risk for myocardial infarction or stroke, especially at younger ages. The ACC/AHA score underestimates the true risk. The excess risk is highest among those with low complement, lupus anticoagulant, or high levels of disease activity. Our risk assessment tool can be useful in guiding efforts to reduce traditional and SLE-related risk factors for “hard“ cardiovascular events among patients with SLE.
To cite this abstract in AMA style:
Petri M, Magder LS. Assessment of 10-Year Risk of Myocardial Infarction or Stroke in SLE [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/assessment-of-10-year-risk-of-myocardial-infarction-or-stroke-in-sle/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-10-year-risk-of-myocardial-infarction-or-stroke-in-sle/