Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with an elevated risk of cardiovascular (CV) disease, largely due to chronic inflammation and its contribution to atherogenesis. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score estimates the probability of advanced coronary artery atherosclerosis using eight factors: age, sex, cholesterol levels, smoking status, blood pressure, presence of obesity, and hyperglycemia. The PREVENT (Predicting Risk of Cardiovascular Disease Events) calculator estimates 10- and 30-year risks for atherosclerotic cardiovascular disease (ASCVD) and heart failure. Both tools are designed for younger populations, making them potentially applicable to patients with SLE, who are at risk of developing premature ASCVD. However, the utility of these new scores in this population remains underexplored. Therefore, the objective was to evaluate the correlation between carotid intima-media thickness (cIMT) and CV risk as estimated by the PDAY and PREVENT tools in patients with SLE.

Methods: A cross-sectional study was conducted including SLE patients aged ≥15 years who met the 2019 ACR/EULAR classification criteria. Patients with established cardiovascular disease, overlap syndromes, or current pregnancy were excluded. Carotid ultrasound was used to assess cIMT via B-mode ultrasonography. PDAY scores and PREVENT 10- and 30-year ASCVD risk estimates were calculated for all participants. The Kolmogorov–Smirnov test assessed data normality. Spearman’s correlation coefficients (rs) were calculated to assess associations between PDAY/PREVENT scores and left/right cIMT values. A p-value ≤0.05 was considered statistically significant.

Results: Thirty-five SLE patients were included (mean age 39.6 ± 13.6 years; 94.2% female). Clinical and disease characteristics are detailed in Table 1. The mean SLEDAI score was 10.1, indicating moderate disease activity. The median PDAY score was 15. The mean 10- and 30-year ASCVD risks estimated by PREVENT were 1.4% and 6.9%, respectively. Mean cIMT measurements were within normal limits: 0.45 cm (left) and 0.44 cm (right). No significant correlations were found between cIMT and either PDAY or PREVENT risk estimates (Figure 1).

Conclusion: This study found no significant association between subclinical atherosclerosis, as measured by cIMT, and cardiovascular risk predictions using the PDAY or PREVENT tools in patients with SLE. These findings highlight the limitations of conventional risk calculators in this population and support the incorporation of direct vascular imaging—such as carotid ultrasound—into routine cardiovascular risk assessment for SLE patients, given their predisposition to early, subclinical atherosclerotic CV disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluating-cardiovascular-risk-in-systemic-lupus-erythematosus-comparing-novel-risk-scores-with-carotid-ultrasound/