Background/Purpose: There is a well-documented increase in atherosclerosis (ATH) in SLE that is not fully explained by traditional risk factors. Several non-Framingham biomarkers, including pro-inflammatory HDL (piHDL), leptin, plasma soluble TNF-like weak inducer of apoptosis (sTWEAK), and homocysteine are individually associated with subclinical ATH in SLE. We previously demonstrated that these biomarkers, combined with clinical variables such as age and diabetes, create a risk profile we have called PREDICTS. The PREDICTS profile more accurately identified SLE patients at risk for future subclinical ATH progression than any one variable alone. We set out to determine whether a high-risk PREDICTS score could also identify patients at risk for future cardiovascular events.

Methods: 392 SLE patients participated in this longitudinal prospective cohort study. 205 patients were included in this analysis, based on availability of 10-year cardiac event and/or mortality data. piHDL was measured using a published cell-free assay. Leptin and sTWEAK were determined at baseline using ELISA (R&D Biosystems). Homocysteine was determined by radioimmunoassay in the clinical laboratory of an academic medical center. Cardiac events were defined as myocardial infarction, a positive stress test, angioplasty, or percutaneous coronary intervention. Cerebrovascular events were defined as stroke or documented TIA. We defined high-risk PREDICTS as ≥ 3 of identified predictors or diabetes + ≥ 1 predictor.

Results: 16.1% (33) of SLE patients experienced a cerebrovascular accident during the 10-year follow-up period. 8.3% (17) of subjects had a cardiac event. 8.3% (17) of subjects died. Patients with a high-risk PREDICTS score at cohort entry were significantly more likely to have a cerebrovascular event (19.1% vs. 7.0%, p=0.04), or a cardiac event (10.9% vs. 0%, p=0.012). In addition, a high-risk baseline PREDICTS score also was also more likely to be found in patients that suffered any cardiovascular event or death (34.4% vs. 7%, p<0.0001). In multivariate analysis, baseline high-risk PREDICTS associated with a 3.7-fold increased odds for death or cardiovascular event over 10 years (p=0.004). Hypertension at baseline also was associated with increased odds for death or cardiovascular event (OR=4.9, p=0.001). No association with death or cardiovascular events were observed with hyperlipidemia, baseline carotid plaque, gender, or tobacco use.

Conclusion: A high-risk PREDICTS score and a history of hypertension at cohort entry confer significantly increased odds for a cardiovascular event or death in SLE patients over a 10-year follow-up. Further studies are necessary to identify proactive treatment strategies to prevent cardiovascular morbidity and mortality in SLE.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-high-cardiovascular-biomarker-panel-risk-score-is-associated-with-increased-10-year-risk-of-cardiovascular-events-and-death-in-sle/