Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE
Objective Studies show that generic cardiovascular risk (CVR) prediction tools may underestimate CVR in SLE. We examined, for the first time to our knowledge, whether generic and disease-adapted CVR scores may predict subclinical atherosclerosis progression in SLE.Methods We included all eligible pa...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-03-01
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| Series: | Lupus Science and Medicine |
| Online Access: | https://lupus.bmj.com/content/10/1/e000864.full |
| _version_ | 1811160197404557312 |
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| author | Maria G Tektonidou Petros P Sfikakis Stylianos Panopoulos George Konstantonis George C Drosos |
| author_facet | Maria G Tektonidou Petros P Sfikakis Stylianos Panopoulos George Konstantonis George C Drosos |
| author_sort | Maria G Tektonidou |
| collection | DOAJ |
| description | Objective Studies show that generic cardiovascular risk (CVR) prediction tools may underestimate CVR in SLE. We examined, for the first time to our knowledge, whether generic and disease-adapted CVR scores may predict subclinical atherosclerosis progression in SLE.Methods We included all eligible patients with SLE without a history of cardiovascular events or diabetes mellitus, who had a 3-year carotid and femoral ultrasound follow-up examination. Five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equation, Globorisk, Prospective Cardiovascular Münster) and three ‘SLE-adapted’ CVR scores (modified Systematic Coronary Risk Evaluation (mSCORE), modified Framingham Risk Score (mFRS), QRESEARCH Risk Estimator V.3 (QRISK3)) were calculated at baseline. The performance of CVR scores to predict atherosclerosis progression (defined as new atherosclerotic plaque development) was tested with Brier Score (BS), area under the receiver operating characteristic curve (AUROC) and Matthews correlation coefficient (MCC), while rank correlation was tested with Harrell’s c-index. Binary logistic regression was also applied to examine determinants of subclinical atherosclerosis progression.Results Twenty-six (21%) of 124 included patients (90% female, mean age 44.4±11.7 years) developed new atherosclerotic plaques after a mean of 39.7±3.8 months’ follow-up period. Performance analysis showed that plaque progression was better predicted by the mFRS (BS 0.14, AUROC 0.80, MCC 0.22) and QRISK3 (BS 0.16, AUROC 0.75, MCC 0.25). c-Index showed no superiority for discrimination between mFRS and QRISK3. In the multivariate analysis, QRISK3 (OR 4.24, 95% CI 1.30 to 13.78, p=0.016) among the CVR prediction scores and age (OR 1.13, 95% CI 1.06 to 1.21, p<0.001), cumulative glucocorticoid dose (OR 1.04, 95% CI 1.01 to 1.07, p=0.010) and antiphospholipid antibodies (OR 3.66, 95% CI 1.24 to 10.80, p=0.019) among disease-related CVR factors were independently associated with plaque progression.Conclusions Application of SLE-adapted CVR scores such as QRISK3 or mFRS, as well as monitoring for glucocorticoid exposure and the presence of antiphospholipid antibodies, can help to improve CVR assessment and management in SLE. |
| first_indexed | 2024-04-10T05:54:39Z |
| format | Article |
| id | doaj.art-fe3345ac9d8a4e65961078f45dc5f454 |
| institution | Directory Open Access Journal |
| issn | 2053-8790 |
| language | English |
| last_indexed | 2024-04-10T05:54:39Z |
| publishDate | 2023-03-01 |
| publisher | BMJ Publishing Group |
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| series | Lupus Science and Medicine |
| spelling | doaj.art-fe3345ac9d8a4e65961078f45dc5f4542023-03-04T03:30:07ZengBMJ Publishing GroupLupus Science and Medicine2053-87902023-03-0110110.1136/lupus-2022-000864Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLEMaria G Tektonidou0Petros P Sfikakis1Stylianos Panopoulos2George Konstantonis3George C Drosos41 First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece12 National and Kapodistrian University of Athens Medical School, Athens, Greece1 Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, “Laiko” hospital, National and Kapodistrian University of Athens, Athens, GreeceJoint Rheumatology Program, National and Kapodistrian University of Athens Faculty of Medicine, Athens, Greece1 First Department of Propaedeutic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, GreeceObjective Studies show that generic cardiovascular risk (CVR) prediction tools may underestimate CVR in SLE. We examined, for the first time to our knowledge, whether generic and disease-adapted CVR scores may predict subclinical atherosclerosis progression in SLE.Methods We included all eligible patients with SLE without a history of cardiovascular events or diabetes mellitus, who had a 3-year carotid and femoral ultrasound follow-up examination. Five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equation, Globorisk, Prospective Cardiovascular Münster) and three ‘SLE-adapted’ CVR scores (modified Systematic Coronary Risk Evaluation (mSCORE), modified Framingham Risk Score (mFRS), QRESEARCH Risk Estimator V.3 (QRISK3)) were calculated at baseline. The performance of CVR scores to predict atherosclerosis progression (defined as new atherosclerotic plaque development) was tested with Brier Score (BS), area under the receiver operating characteristic curve (AUROC) and Matthews correlation coefficient (MCC), while rank correlation was tested with Harrell’s c-index. Binary logistic regression was also applied to examine determinants of subclinical atherosclerosis progression.Results Twenty-six (21%) of 124 included patients (90% female, mean age 44.4±11.7 years) developed new atherosclerotic plaques after a mean of 39.7±3.8 months’ follow-up period. Performance analysis showed that plaque progression was better predicted by the mFRS (BS 0.14, AUROC 0.80, MCC 0.22) and QRISK3 (BS 0.16, AUROC 0.75, MCC 0.25). c-Index showed no superiority for discrimination between mFRS and QRISK3. In the multivariate analysis, QRISK3 (OR 4.24, 95% CI 1.30 to 13.78, p=0.016) among the CVR prediction scores and age (OR 1.13, 95% CI 1.06 to 1.21, p<0.001), cumulative glucocorticoid dose (OR 1.04, 95% CI 1.01 to 1.07, p=0.010) and antiphospholipid antibodies (OR 3.66, 95% CI 1.24 to 10.80, p=0.019) among disease-related CVR factors were independently associated with plaque progression.Conclusions Application of SLE-adapted CVR scores such as QRISK3 or mFRS, as well as monitoring for glucocorticoid exposure and the presence of antiphospholipid antibodies, can help to improve CVR assessment and management in SLE.https://lupus.bmj.com/content/10/1/e000864.full |
| spellingShingle | Maria G Tektonidou Petros P Sfikakis Stylianos Panopoulos George Konstantonis George C Drosos Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE Lupus Science and Medicine |
| title | Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE |
| title_full | Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE |
| title_fullStr | Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE |
| title_full_unstemmed | Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE |
| title_short | Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE |
| title_sort | generic and disease adapted cardiovascular risk scores as predictors of atherosclerosis progression in sle |
| url | https://lupus.bmj.com/content/10/1/e000864.full |
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