Assessing the validity of QRISK3 in predicting cardiovascular events in systemic lupus erythematosus

Zhu, Lisa; Singh, Manpreet; Lele, S.; Sahakian, Lori; Grossman, Jennifer; Hahn, Bevra H.; McMahon, Maureen

doi:10.1136/lupus-2021-000564

Cited by 16 publications

(14 citation statements)

References 14 publications

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“…We consider that this heterogeneity is due to the varied conditions in the different scenarios in which SLE clinical practice and research are developed. In the absence of a robust recommendation applicable to all patients, the assessment of individual cardiovascular risk relies on the judgment of physicians and their experience in the application of risk scores and laboratory and imaging methods [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The incorporation of SLE and the use of corticosteroids in risk scores seems to be a step in the right direction to establish a more accurate cardiovascular risk stratification tool for patients with SLE, although further optimization, standardization, and simplification are needed for use in daily practice [ 6 , 13 , 14 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…For optimal prevention and treatment of atherosclerosis, it is not self-evident that women and men show similar responses to risk factors or treatment; therefore, studies must present results according to sex. Whether the threat and risk factors of premature atherosclerosis in women with SLE are generalized to male patients is unknown [ 3 , 26 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps—A Rapid Scoping Review

Hernández-Negrín

Ricci

Mancebo-Sevilla

et al. 2022

IJERPH

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Obesity, diabetes mellitus, and cardiovascular risk are real challenges in systemic lupus erythematosus (SLE) clinical practice and research. The evidence of the burden of these health problems in SLE patients is determined by the methods used to assess them. Therefore, the aim of this scoping review is to map current approaches in assessing obesity, diabetes mellitus, and cardiovascular risk burden in SLE patients and to identify existing knowledge gaps in this field. This rapid scoping review was conducted according to the Joanna Briggs Institute methodology and identified 274 articles, of which 73 were included. Most studies were conducted at European institutions and patients were recruited from specialist hospital clinics, the majority of whom were women. The burden of obesity and diabetes mellitus for SLE patients was assessed mainly in terms of prevalence, impact on disease activity, and cardiometabolic risk. The burden of cardiovascular risk was assessed using multiple approaches, mainly imaging and laboratory methods, and risk factor-based scores, although there is great heterogeneity and uncertainty between the methods used. This review highlights the importance of improving and standardizing the approach to obesity, diabetes, and cardiovascular risk in SLE patients through a holistic assessment that includes lifestyle, clinical, biological, and social aspects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps—A Rapid Scoping Review

Hernández-Negrín

Ricci

Mancebo-Sevilla

et al. 2022

IJERPH

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“…Recent reports suggest that QRisk3 may be a better predictor for lupus patients than other estimators of future ASCVD event risk. [57,58] Additional clinical parameters that may enhance assessment of ASCVD event risk in lupus patients may include plasma apoB measurements, [1,59] one-time assessments of plasma lipoprotein(a) levels, which are still largely genetically determined [1] , and arterial imaging to detect subclinical plaque by iliofemoral or carotid ultrasonography or magnetic resonance imaging; coronary, iliofemoral, or carotid coronary CT angiography; and in older patients coronary artery calcium scores. [1]…”

Section: Discussionmentioning

confidence: 99%

The State of Current Management of the Heightened Risk for Atherosclerotic Cardiovascular Events in an Established Cohort of Patients With Lupus Erythematosus

Zhao

Feng

Werth

et al. 2022

Preprint

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Aims: Patients with lupus erythematosus (LE) are at a heightened risk for clinical events, chiefly heart attacks and strokes, caused by atherosclerotic cardiovascular disease (ASCVD). To address this problem, we recently proposed new guidelines for categorization of levels of risk for future ASCVD events specifically in LE patients, with corresponding recommendations for management. Methods and Results: We included all participants in our established UPenn Longitudinal Lupus Cohort of patients with cutaneous LE, without or with concurrent systemic LE (n=370, LE-ASCVD Study Cohort, years 2007 to 2021). Of our LE-ASCVD Study Cohort, 336/370 (90.8%) had a designated primary care physician. By the new guidelines, the most recent plasma low-density lipoprotein cholesterol (LDLc) levels were above goal for 252/370 (68.1%) of the LE-ASCVD Study Cohort. Of the Study Cohort, 266 (71.9%) had hypertension, which was under- or un-treated in 198/266 (74.4%). Of current smokers, 51/63 (81.0%) have no chart documentation of smoking cessation counseling or clinic referral. Diabetes was generally well-managed, and hypertriglyceridemia was uncommon. Of the LE-ASCVD Study Cohort, 254 patients qualified for two widely used online calculators that estimate the risk of an ASCVD event in the next 10 years (10-year ASCVD event risk): the ACC-ASCVD Risk Estimator Plus and QRisk3. We also stratified these 254 patients into the categories of ASCVD event risk defined by Keyes et al. Surprisingly, these three methods for estimating ASCVD event risk showed clinically meaningful agreement for only 100/254 (39.4%), i.e., discordance for over 60% of LE patients that could affect their clinical management. The actual documented rate of ASCVD events for patients in the first 10 years after enrollment into the Cohort was 22.3% (95% CI 16.9%, 27.4%), indicating a high-risk population despite a preponderance of women and a median age of only 47 years at enrollment. Conclusion: We conclude that cutaneous LE patients are under-treated compared with the new guidelines and, accordingly, these patients experience a substantial burden of major adverse ASCVD events. Moreover, it is unclear how to accurately assess future ASCVD event risk in cutaneous LE patients - except that it is high - and this uncertainty may complicate clinical management. Efforts are underway to improve ASCVD event risk estimation and guideline implementation in lupus patients.

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“…Measures for CVR assessment in SLE include generic CVR prediction tools and ‘SLE-adapted’ risk equations that incorporate the presence of SLE and/or disease features 13 14. The validity of various generic CVR prediction tools is not fully elucidated, while evidence about the preferential use of disease-specific risk tools is inconclusive 13–19. The recent ‘EULAR Recommendations for CVR Management in RMDs Including SLE and Antiphospholipid Syndrome’ did not endorse the use of any particular CVR assessment tool due to limitations of the current evidence 12…”

Section: Introductionmentioning

confidence: 99%

Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE

et al. 2023

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ObjectiveStudies 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.MethodsWe 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’sc-index. Binary logistic regression was also applied to examine determinants of subclinical atherosclerosis progression.ResultsTwenty-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.ConclusionsApplication 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.

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Assessing the validity of QRISK3 in predicting cardiovascular events in systemic lupus erythematosus

Cited by 16 publications

References 14 publications

Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps—A Rapid Scoping Review

Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps—A Rapid Scoping Review

The State of Current Management of the Heightened Risk for Atherosclerotic Cardiovascular Events in an Established Cohort of Patients With Lupus Erythematosus

Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE

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