Personalizing cardiovascular risk prediction for patients with systemic lupus erythematosus
- PMID: 38788567
- PMCID: PMC11214838
- DOI: 10.1016/j.semarthrit.2024.152468
Personalizing cardiovascular risk prediction for patients with systemic lupus erythematosus
Abstract
Objective: Cardiovascular disease (CVD) risk is increased in SLE and underestimated by general population prediction algorithms. We aimed to develop a novel SLE-specific prediction tool, SLECRISK, to provide a more accurate estimate of CVD risk in SLE.
Methods: We studied patients in the Brigham and Women's Hospital SLE cohort. We collected one-year baseline data including the presence of traditional CVD factors and SLE-related features at cohort enrollment. Ten-year follow-up for the first major adverse cardiovascular event (MACE; myocardial infarction (MI), stroke, or cardiac death) began at day +1 following the baseline period (index date). ICD-9/10 codes identified MACE were adjudicated by board-certified cardiologists. Least absolute shrinkage and selection operator regression selected SLE-related variables to add to the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equations 10-year risk Cox regression model. Model fit statistics and performance (sensitivity, specificity, positive/negative predictive value, c-statistic) for predicting moderate/high 10-year risk (≥7.5 %) of MACE were assessed and compared to ACC/AHA, Framingham risk score (FRS), and modified FRS (mFRS). Optimism adjustment internal validation was performed using bootstrapping.
Results: We included 1,243 patients with 90 MACEs (46 MIs, 36 strokes, 19 cardiac deaths) over 8946.5 person-years of follow-up. SLE variables selected for the new prediction algorithm (SLECRISK) were SLE activity (remission/mild vs. moderate/severe), disease duration (years), creatinine (mg/dL), anti-dsDNA, anti-RNP, lupus anticoagulant, anti-Ro positivity, and low C4. The sensitivity for detecting moderate/high-risk (≥7.5 %) of MACE using SLECRISK was 0.74 (95 %CI: 0.65, 0.83), which was better than the sensitivity of the ACC/AHA model (0.38 (95 %CI: 0.28, 0.48)). It also identified 3.4-fold more moderate/high-risk patients than the ACC/AHA. Patients who were moderate/high-risk according to SLECRISK but not ACC/AHA, were more likely to be young women with severe SLE and few other traditional CVD risk factors. Model performance between SLECRISK, FRS, and mFRS were similar.
Conclusion: The novel SLECRISK tool is more sensitive than the ACC/AHA for predicting moderate/high 10-year risk for MACE and may be particularly useful in predicting risk for young females with severe SLE. Future external validation studies utilizing cohorts with more severe SLE are needed.
Keywords: Cardiovascular risk; Prediction; Systemic lupus erythematosus.
Copyright © 2024. Published by Elsevier Inc.
Conflict of interest statement
Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Dr. Choi has consulted for Celltrion, Werfen, Organon, MitogenDx, AstraZeneca, and Mallinckrodt Canada Inc. Dr. Everett has grants from Novo Nordisk and has consulted for Ipsen Pharmaceuticals, Eli Lilly and Company, Janssen, Novo Nordisk, and Roche Diagnostics. Dr. Costenbader has consulted for or collaborated on research projects with Glaxo Smith Kline, Gilead, CabalettaBio, Exagen Diagnostics, Eli Lilly, Merck, Astra Zeneca and Neutrolis (less than $10,000 each). Dr. Weber has consulted for Bristol-Myers Squibb(BMS), Horizon Therapeutics, Kiniksa, and Novo Nordisk.
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