Differences in cardiovascular risk factor control between primary and systemic lupus erythematosus-related antiphospholipid syndrome in a multiethnic cohort of 1003 patients with antiphospholipid syndrome: the SUrvey of cardiovascular disease Risk Factors (SURF) in SLE and APS project

Eleana Bolla¹, Anne Grete Semb², Michelle Petri³, Petros Sfikakis⁴, Bahar Artim Esen⁵, Gabriela Hernandez-Molina⁶, Eric Hachulla⁷, Haner Direskeneli⁸, George Karpouzas⁹, Marta Mosca¹⁰, Mohit Goyal¹¹, Nathalie Costedoat-Chalumeau¹², Angela Tincani¹³, Ayten Yazici¹⁴, Karoline Lerang¹⁵, Anne Troldborg¹⁶, Sofia Ajeganova¹⁷, Tatiana Popkova¹⁸, Elisabet Svenungsson¹⁹, Nikos Pantazis²⁰ and Maria Tektonidou²¹, ¹Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece, ²Preventive Cardio-Rheuma clinic, Dept Rheum, Diakonhjemmet Hospital, Oslo, Norway, Oslo, Norway, ³Johns Hopkins University School of Medicine, Timonium, MD, ⁴NKUA - SCHOOL OF MEDICINE, Athens, Greece, ⁵Istanbul University, Istanbul, Istanbul, Turkey, ⁶Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Federal District, Mexico, ⁷University of Lille, LILLE, France, ⁸Marmara University, ISTANBUL, Turkey, ⁹Harbor-UCLA Medical Center, Torrance, CA, ¹⁰University of Pisa, Pisa, Pisa, Italy, ¹¹CARE Pain & Arthritis Centre, Udaipur, Rajasthan, India, ¹²Inserm DR Paris ⁵, Paris, France, ¹³ASST Spedali Civili-University of Brescia, Gussago, Brescia, Italy, ¹⁴Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey, ¹⁵Department of Rheumatology, Oslo University Hospital, Oslo, Norway, ¹⁶Aarhus University Hospital, Aarhus, Denmark, ¹⁷Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden, ¹⁸V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia, ¹⁹Karolinska Institutet, Stockholm, Stockholms Lan, Sweden, ²⁰Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece, ²¹National and Kapodistrian University of Athens, Athens, Greece

Meeting: ACR Convergence 2025

Keywords: antiphospholipid syndrome, Cardiovascular, risk factors, Systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, October 26, 2025

Title: (0115–0144) Antiphospholipid Syndrome Poster

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Cardiovascular disease (CVD) in antiphospholipid syndrome (APS) is driven by antiphospholipid antibody-mediated immunothrombotic mechanisms and traditional cardiovascular risk factors (CVRFs). Although the EULAR recommendations for cardiovascular risk management highlighted the importance of CVRF control, CVRF target achievement and the differences between primary APS (PAPS) and systemic lupus erythematosus (SLE)/APS remain uncertain. In the context of the SUrvey of Cardiovascular Disease Risk Factors-SURF in SLE and APS project (1), this study aimed to assess the prevalence and control of traditional CVRFs in a multi-centre group of SLE/APS and PAPS patients across four continents.

Methods: CVRF data were collected from medical records in 17 centres from 11 countries between 2015 and 2020 (extended to 2022 due to COVID-19 pandemic). We evaluated the prevalence of traditional CVRFs, and individual’s cardiovascular risk (low/moderate/high/very-high) using the Systematic Coronary Risk Evaluation (SCORE) algorithm. Target attainment was assessed for the following CVRFs: blood pressure (BP) (< 140/90 mm Hg), lipids, smoking, and body mass index (BMI) according to 2016 European Society of Cardiology guidelines, as well as a composite CVRF (at least two, three, and all four CVRF targets of BP, smoking, low-density lipoprotein [LDL], BMI). An additional BP target of < 130/80 mmHg was assessed according to the 2022 EULAR recommendations for cardiovascular risk management. Multivariable regression models were applied.

Results: 1003 patients meeting the Sydney APS criteria (median age 47.0 years, females: 77.7%, White: 66.2%, median disease duration 11.0 years) were included; 539 with PAPS and 464 with SLE/APS (additionally fulfilling 2012 ACR SLE classification criteria). We found a high CVRF prevalence (hypertension 41.0%, hyperlipidemia 34.3%, obesity 32.1%, current smoking 19.3%) and inadequate individual (BP < 130/80 mm Hg, body mass index [BMI], lipids) and multiple CVRF control in the entire APS cohort. Higher prevalence of hypertension (50.4% vs 32.8%, p< 0.001) and hyperlipidemia (39.7% vs 29.7%, p=0.001) was observed in SLE/APS versus PAPS, but a lower prevalence of current smoking (15.9% vs 22.3%, p=0.012). Patients with PAPS had worse target attainment than SLE/APS patients for smoking (no current smoking) (77.7% vs 84.1%, p=0.012), BP < 130/80 mmHg (47.9% vs 56.6%, p=0.007) and ≥2 CVRF targets in the entire group, and additionally for BMI, LDL, triglycerides and ≥3 CVRF targets in the high/very high CVD risk subgroup. In multivariable analysis, age, sex and arterial thrombosis history, were the main independent predictors of ≥3 and four target attainment.

Conclusion: In this large real-world survey, high prevalence and suboptimal CVRF control were observed in APS, highlighting the need for increased CVD risk awareness, especially in PAPS, a clinical entity with frequently under-recognised cardiovascular risk compared to SLE.References:1. Bolla E et al. Prevalence and target attainment of traditional cardiovascular risk factors in patients with systemic lupus erythematosus: a cross-sectional study including 3401 individuals from 24 countries. Lancet Rheumatol. 2024 :e447–59.

Disclosures: E. Bolla: None; A. Semb: None; M. Petri: Amgen, 2, AnaptysBio, 2, Annexon Bio, 2, AstraZeneca, 2, 5, Atara Biosciences, 2, Aurinia, 2, 5, Autolus, 2, Bain Capital, 2, Baobab Therapeutics, 2, Biocryst, 2, Biogen, 2, Boxer Capital, 2, Cabaletto Bio, 2, Caribou Biosciences, 2, CTI Clinical Trial and Consulting Services, 2, CVS Health, 2, Dualitybio, 2, Eli Lilly, 2, 5, EMD Serono, 2, Emergent, 2, Escient Pharmaceuticals, 2, Exagen, 5, Exo Therapeutics, 2, Gentibio, 2, GlaxoSmithKlein(GSK), 2, 5, iCell Gene Therapeutics, 2, Innovaderm Research, 2, IQVIA, 2, Janssen, 5, Kezar Life Sciences, 2, Kira Pharmaceuticals, 2, Nexstone Immunology, 2, Nimbus Lakshmi, 2, Novartis, 2, Ono Pharma, 2, PPD Development, 2, Proviant, 2, Regeneron, 2, Seismic Therapeutic, 2, Senti Biosciences, 2, Sinomab Biosciences, 2, Steritas, 2, Takeda, 2, Tenet Medicines, 2, TG Therapeutics, 2, UCB, 2, Variant Bio, 2, Worldwide Clinical Trials, 2, Zydus, 2; P. Sfikakis: None; B. Artim Esen: None; G. Hernandez-Molina: None; E. Hachulla: AstraZeneca, 2, 6, Boehringer-Ingelheim, 2, CSL Behring, 5, GlaxoSmithKlein(GSK), 2, 5, 6, Johnson & Johnson, 2, 5, 6, Novartis, 2, 5, Pfizer, 5, Roche-Chugai, 5, Sanofi-Genzyme, 2, 5, Sobi, 5; H. Direskeneli: None; G. Karpouzas: Janssen, 1, Pfizer, 5, Scipher, 2; M. Mosca: AbbVie, 2, AstraZeneca, 2, 6, Biogen, 2, BMS, 2, Eli Lilly, 6, GSK, 2, 5, 6, Idorsia, 2, Milteny, 2, Novartis, 2, Otsuka, 2, 6, UCB, 2, 6; M. Goyal: None; N. Costedoat-Chalumeau: Bristol-Myers Squibb(BMS), 6, Roche, 5, UCB Pharma France, 5; A. Tincani: Galapagos, 1, UCB, 1; A. Yazici: None; K. Lerang: None; A. Troldborg: None; S. Ajeganova: None; T. Popkova: None; E. Svenungsson: AstraZeneca, 11, Pfizer, 11; N. Pantazis: None; M. Tektonidou: None.

To cite this abstract in AMA style:

Bolla E, Semb A, Petri M, Sfikakis P, Artim Esen B, Hernandez-Molina G, Hachulla E, Direskeneli H, Karpouzas G, Mosca M, Goyal M, Costedoat-Chalumeau N, Tincani A, Yazici A, Lerang K, Troldborg A, Ajeganova S, Popkova T, Svenungsson E, Pantazis N, Tektonidou M. Differences in cardiovascular risk factor control between primary and systemic lupus erythematosus-related antiphospholipid syndrome in a multiethnic cohort of 1003 patients with antiphospholipid syndrome: the SUrvey of cardiovascular disease Risk Factors (SURF) in SLE and APS project [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/differences-in-cardiovascular-risk-factor-control-between-primary-and-systemic-lupus-erythematosus-related-antiphospholipid-syndrome-in-a-multiethnic-cohort-of-1003-patients-with-antiphospholipid-sy/. Accessed .

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