SCORE2 versus SCORE in patients with systemic lupus erythematosus

Abstract

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.

The Link Between Dysregulated Immunometabolism and Vascular Damage: Implications for the Development of Atherosclerosis in Systemic Lupus Erythematosus and Other Rheumatic Diseases

“…4,7 Some improvements have been made over time, improving upon SCORE to yield SCORE2; however, this calculator is relatively new and has so far only been tested on White patients with SLE, thus limiting its generalizability at a global level. 59 The use of traditional risk factors to diagnose CVD in non-SLE individuals is also limiting, as the presence of undiagnosed SLE could potentially challenge the diagnosis of CVD in certain groups, such as perimenopausal women, who historically do not form the "traditional" CVD demographic. Additionally, early events that govern the development of atherosclerosis still remain unclear.…”

Lipid profile of postmenopausal women

“…SCORE2 tables change not only the approach to the assessment of cardiovascular risk, but also the target value of LDL cholesterol, which needs to be adjusted to the latest guidelines in accordance with the estimated cardiovascular risk, and thus the indications for the use of pharmacological therapy. 25 A similar study was conducted in which 1168 patients with rheumatoid arthritis participated. According to the SCORE table, 12% of the respondents belonged to the high risk category, and 8% of the respondents belonged to the very high risk category.…”

Managing Cardiovascular Risk in Systemic Lupus Erythematosus: Considerations for the Clinician

“… 49 Additionally, an updated SCORE prediction model, SCORE2, was developed using more recent CVD rates and by accounting for fatal and non-fatal CVD events, and demonstrated a higher ability to predict the presence of subclinical atherosclerosis in a cross-sectional study, compared to SCORE. 50 …”