QRISK3 relation to carotid plaque is higer than that of score in patients with systemic lupus erythematosus

Quevedo-Abeledo, Juan Carlos; Cáceres, Laura; Palazuelos, Camilo; Llorca, Javier; Ferraz-Amaro, Iván

doi:10.1093/rheumatology/keab531

Cited by 10 publications

(7 citation statements)

References 30 publications

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“…While QRISK3 missed a lower but not negligible proportion of high-risk patients according to plaque presence at baseline in a previous study from our group, 16 a good performance to predict plaque progression and a significant association with plaque progression in multivariate analysis was detected in the current study, supporting its role as a promising tool for CVR assessment in SLE. A positive correlation between QRISK3 and carotid IMT, carotid distention and diameter analysis, arterial stiffness, 37 pulse wave velocity 38 and carotid plaques 39 has been previously described. Regrettably, validation studies for cardiovascular events in multiethnic datasets are scarce for QRISK3, supporting the need for studies in individuals from various geographical settings as well as external validation in large, multicentre SLE populations.…”

Section: Discussionmentioning

confidence: 54%

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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Section: Discussionmentioning

confidence: 54%

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

et al. 2023

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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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“…In a recent work by our group, QRESEARCH risk estimator version 3 (QRISK3), which was developed in 2017, showed a discrimination for subclinical atherosclerosis higher than that of SCORE in patients with SLE. 3 SCORE was developed from cohorts recruited before 1986 and, to date, has not been systematically recalibrated to contemporary CV disease rates. We believe that those CV risk calculation systems developed in recent years, such as QRISK3 and SCORE2, may be more accurate at predicting CV events not only in the general European population, but also in patients with inflammatory diseases.…”

Section: Discussionmentioning

confidence: 99%

“…As seen in other inflammatory diseases, current cardiovascular (CV) risk calculation tools used in the general population underestimate the actual CV risk of patients with SLE. [2][3][4] For example, in a previous report of SLE patients without prior CVD or diabetes, five generic and three SLEadapted clinical risk scores underestimated high CVD risk as defined by the presence of atherosclerotic plaque. 4 This was also the case with the Systematic Coronary Risk Assessment (SCORE) CV death risk calculator, which was developed in 2003 for use in European populations.…”

Section: Introductionmentioning

confidence: 96%

SCORE2 versus SCORE in patients with systemic lupus erythematosus

Quevedo-Abeledo

Ferraz-Amaro

2022

Therapeutic Advances in Musculoskeletal

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Introduction: Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular (CV) disease. Recently, the Systematic Coronary Risk Assessment (SCORE), a well-known CV risk algorithm, has been updated to a new predictive model (SCORE2). This new algorithm improves the identification of individuals at high risk of developing CV disease across Europe. Since carotid atherosclerosis is a predictor of future CV events and CV death, our objective was to compare the predictive capacity of SCORE2 versus SCORE for the presence of subclinical carotid atherosclerosis in patients with SLE. Methods: Two hundred and thirty-five individuals over 40 years of age diagnosed with SLE were consecutively recruited in this cross-sectional study. SCORE and SCORE2 were calculated. The relationship of SCORE and SCORE2 with each other, and with the presence of subclinical carotid atherosclerosis (both carotid plaque and carotid intima media thickness -cIMT-), was studied. Results: SCORE2 and SCORE did not correlate with each other (Spearman’s Rho = 0.125, p = 0.065). Although SCORE did not correlate with cIMT (Spearman’s Rho = -0.022, p = 0.75), the correlation of SCORE2 with cIMT was statistically significant (Spearman’s Rho = 0.367, p < 0.001). Similarly, SCORE did not show significant discrimination for the presence of carotid plaque [AUC = 0.521 (95% CI = 0.443–0.600)], while SCORE2 did [AUC = 0.720 (95% CI = 0.656–0.785)]. The difference between AUCs was found to be statistically significant ( p < 0.001), thus showing that the prediction capacity of SCORE2 was significantly higher than that of SCORE. Conclusion: In SLE patients, the ability of SCORE2 to predict the presence of subclinical atherosclerosis is higher than that of SCORE. According to our results, SCORE2, rather than SCORE, should be used in the CV risk stratification of patients with SLE. Prospective studies are needed to confirm these findings.

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QRISK3 relation to carotid plaque is higer than that of score in patients with systemic lupus erythematosus

Cited by 10 publications

References 30 publications

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

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

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

SCORE2 versus SCORE in patients with systemic lupus erythematosus

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