PO:16:238 | Cardiovascular risk in systemic lupus erythematosus patients: comparison among Framingham Score, QRISK3, and SLECRE

Francesca Vignoni^1|2, Serena Iodice², Cesare Tomasi², Chiara Orlandi^1|2, Eleonora Pedretti¹, Micaela Fredi², Franco Franceschini^1|2, Ilaria Cavazzana^1|2. | ¹Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Brescia, Italy; ²Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Background. Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease associated with a high risk of developing cardiovascular (CV) events (1). The aim of this study is to analyse the performance of the main CV risk calculators, Framingham Score, QRISK3, and SLECRE (2), in predicting CV events at 10 years.

Methods. We enrolled 82 SLE patients, with a minimum follow-up of 10 years and complete data on SLE features, disease activity (as SLEDAI-2K) and CV risk factors. Clinical and serological data were collected from clinical charts. CV risks were calculated at the CV event (at the last follow-up for controls) and 10 years before. A p-value lower than or equal to 0.05 was considered statistically significant.

Results. Figure 1 shows demographic, CV risk data of the 82 patients (Table 1), and the distribution of 27 CV events (Graphic 1). CV events were associated with male sex (p: 0.01), longer SLE history (p: 0.014), and higher values of SLEDAI-2K at the event and 10 years before (p: 0.0023 and p: 0.0003, respectively). No differences in autoantibodies’ or clinical data were detected between groups. Considering risk factors, higher systolic pressure (p: 0.007) and chronic kidney disease (p<0.0001) were the only items associated with CV events, 10 years before. Stratifying patients in low (<10%), intermediate (11-20%), and high (>20%) CV risk, only SLECRE >20%, assessed 10 years before the CV event or before the last follow-up, was significantly associated with the CV event development at 10 years [OR: 5 (IC 95%: 1.8–13.6); p: 0.002]. FRS and QRISK3 stratification did not differ between CV event development and controls. Only anti-beta2glycoprotein-I, anti-dsDNA antibodies, lupus nephritis, and complement reduction were associated with SLECRE >10%, assessed 10 years before the last available, independently from CV event occurrence.

Conclusion. SLECRE calculator demonstrated the best performance in identifying patients at risk to develop CV events at 10 years, compared with Framingham Score and QRISK3. This is due to the inclusion of differently weighted items, such as traditional CV risk factors, disease activity and lupus anticoagulant.

References

1. Schoenfeld SR, et al. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Semin Arthritis Rheum. 2013;43:77–95.

2. Sivakumaran J, et al. Assessment of cardiovascular risk tools as predictors of cardiovascular disease events in systemic lupus erythematosus. Lupus Science and Medicine 2021;8:e000448.