Background/Purpose:

It has been well established that patients with systemic lupus erythematosus (SLE) have an increased risk of developing cardiovascular disease (CVD). Traditional CVD risk calculators such as the Framingham risk score (FRS) have been shown to underestimate risk in this patient population. QRISK3 is unique in including SLE and corticosteroid use as risk factors and has been shown to enhance CVD risk detection in a cohort of SLE patients in the UK. The purpose of this study was to assess the validity of QRISK3 compared to other cardiovascular risk models (FRS, modified FRS and PREDICTS) in predicting CVD risk in a cohort of SLE patients in the United States.

Methods: We studied a prospective cohort of 309 patients with SLE without prior history of any cardiovascular event, defined as coronary artery disease (CAD), myocardial infarction (MI), ischemic stroke, transient ischemia attack (TIA) or peripheral artery disease (PAD). Patients received care at an academic medical center and were followed over a 10-year period. Baseline data on demographic factors, diagnosis and clinical values were obtained via chart review and used to calculate QRISK3, FRS, modified FRS (FRS multiplied by 2, as described by Urowitz et al., 2016) and PREDICTS (Predictors of Risk for Elevated Flares, Damage Progression, and Increased Cardiovascular Disease in Patients with SLE) scores.  Chi-squared test was used for dichotomous variables and Student’s t-test for continuous variables. Receiver operator characteristic (ROC) curves were created using SPSS software to evaluate the diagnostic performance of QRISK3, FRS, modified FRS and PREDICTS using a threshold of risk greater than 10% for the first 3 calculators and “high-risk” categorization for PREDICTS.

Results: The cohort was composed of 98% females, and the mean age of all patients was 42.3 years. Sixty-three of the 309 patients (20.2%) experienced a cardiovascular event during the 10-year follow-up period. Forty-six percent of patients who had a cardiovascular event had a QRISK3 risk score greater than 10%, whereas 19.1% of patients who did not have an event had a QRISK3 score greater than 10% (p< 0.001). In comparison, 11% of patients who had a cardiovascular event had a FRS greater than 10%, whereas 6.2% who did not have an event had an FRS greater than 10% (p=0.17). The corresponding numbers for modified FRS and PREDICTS were 41.3% and 28.0% (p=0.04), and 67% and 36% (p< 0.001), respectively. A QRISK3 score greater than 10% had sensitivity of 46.0% and specificity of 80.9%, with comparison to other calculators shown in Table 1. The area under the ROC using QRISK3 greater than 10% was larger than that using FRS or modified FRS greater than 10%, though it was slightly smaller than that using high PREDICTS score (Table 2).

Conclusion: Both QRISK3 and PREDICTS demonstrated better performance at predicting risk of CVD in this cohort of SLE patients compared to FRS and modified FRS. These results indicate that QRISK3 may be a more useful risk assessment tool in this population compared to traditional calculators.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-the-validity-of-qrisk3-at-predicting-cardiovascular-events-in-systemic-lupus-erythematosus-patients/