An unmet need exists in predicting cardiovascular events (CVEs) risk in patients with systemic lupus erythematosus (SLE). The existing prediction tools including the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score are inaccurate in predicting SLE-related CV risk factors. Hence, several studies are being conducted to develop SLE-specific predictions tool. Now, a group of Boston researchers has developed a novel disease-specific CV disease prediction tool for identifying SLE patients at high risk for CVEs over 10 years. The study findings have been presented at the Canadian Rheumatology Association (CRA) 2023 annual scientific meeting.
Dr. Choi and his team developed the new risk prediction tool by incorporating lupus-related variables (ASCVD risk score, disease activity, disease duration, creatinine level, presence of anti-dsDNA, anti-RNP, lupus anticoagulant, anti-Ro60/SSA, and low C4) and the traditional CV disease risk factors. One-year assessment using the novel tool showed a 2-fold increase in the number of SLE patients at high risk than ASCVD risk score alone or ASCVD combined with selected SLE variables.
A 2021 study by Dr. Skaggs and co-researchers also developed a risk prediction score named ‘predictors of risk for elevated flares, damage progression, and increased cardiovascular disease in patients with SLE (PREDICTS)’. They combined age and diabetes factors with previously identified four biomarkers (proinflammatory high-density lipoprotein, leptin, soluble TNF-like weak inducer of apoptosis (sTWEAK), and homocysteine) to develop this profile. They have found PREDICTS risk profile to be more useful in predicting the progression of subclinical atherosclerosis among SLE patients. Compared to the Framingham risk factor panel, the PREDICTS panel showed an overall better predictive ability for CVEs or death in SLE patients.
Though several tools are being developed for predicting CV risk in SLE patients, recommendations for conducting the customized evaluation of CVD risk factors in SLE patients are obscure. Further research is warranted to investigate the performance of newer customized tools prior to their implementation in clinical practice.
References
- Choi MY, Weber B, Guan H, Yoshida K, Li D, Eldrodt J, et al. POD02 Personalizing cardiovascular risk prediction for SLE patients. Canadian Rheumatology Association & Arthritis Health Professions Association Annual Scientific Meeting 2023. Podium Abstracts.https://asm.rheum.ca/wp-content/uploads/2023/01/2023-Podium-Presentations-for-website.pdf
- Skaggs BJ, Grossman J, Sahakian L, Perry L, FitzGerald J, Charles‐Schoeman C, et al. A panel of biomarkers associates with increased risk for cardiovascular events in women with systemic lupus erythematosus. ACR open rheumatology. 2021 Apr;3(4):209-20.