TY - JOUR
T1 - Development of a systemic lupus erythematosus cardiovascular risk equation
AU - Petri, Michelle A.
AU - Barr, Erik
AU - Magder, Laurence S.
N1 - Funding Information:
Funding The Hopkins Lupus Cohort is supported by NIH Grants AR043727 and AR069572.
Publisher Copyright:
© 2019 Author(s).
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Objective Accelerated atherosclerosis remains the major cause of late death (after 5 years) in SLE. Yet, the â traditional' cardiovascular risk equations (such as Framingham) consistently underestimate the risk. We sought to construct a data-driven formula for cardiovascular risk in SLE, based on data collected during the first year in a longitudinal cohort, for research purposes. Methods Two risk formulas were derived: One was for a broad set of cardiovascular outcomes (myocardial infarction, stroke, onset of angina, coronary procedures such as bypass or stent, claudication, peripheral artery disease or congestive heart failure); and the other for hard outcomes (myocardial infarction or stroke). Traditional and SLE-specific risk factors for cardiovascular disease were measured during the first year of cohort participation. Using Cox proportional hazards modelling, SLE formulas to calculate the 10-year risk of a subsequent cardiovascular event were derived and compared with the Framingham (for the broader outcome) and American College of Cardiology formulas (for the hard outcomes). Results SLE-related risk factors for each model included mean disease activity score (as measured by the SELENA revision of the SLE Disease Activity Index), low C3 and history of lupus anticoagulant. In those with SLE-related risk factors, the estimated 10-year risk based on our formula was substantially higher than the risk estimated based on the formulas for the general population. Conclusions The excess cardiovascular risk among patients with SLE varies substantially depending on the SLE-related risk factors, age and traditional risk factors. Cardiovascular risk formulas based on individual data from patients with SLE may better estimate 10-year cardiovascular risk among patients with SLE than the Framingham or American College of Cardiology equations.
AB - Objective Accelerated atherosclerosis remains the major cause of late death (after 5 years) in SLE. Yet, the â traditional' cardiovascular risk equations (such as Framingham) consistently underestimate the risk. We sought to construct a data-driven formula for cardiovascular risk in SLE, based on data collected during the first year in a longitudinal cohort, for research purposes. Methods Two risk formulas were derived: One was for a broad set of cardiovascular outcomes (myocardial infarction, stroke, onset of angina, coronary procedures such as bypass or stent, claudication, peripheral artery disease or congestive heart failure); and the other for hard outcomes (myocardial infarction or stroke). Traditional and SLE-specific risk factors for cardiovascular disease were measured during the first year of cohort participation. Using Cox proportional hazards modelling, SLE formulas to calculate the 10-year risk of a subsequent cardiovascular event were derived and compared with the Framingham (for the broader outcome) and American College of Cardiology formulas (for the hard outcomes). Results SLE-related risk factors for each model included mean disease activity score (as measured by the SELENA revision of the SLE Disease Activity Index), low C3 and history of lupus anticoagulant. In those with SLE-related risk factors, the estimated 10-year risk based on our formula was substantially higher than the risk estimated based on the formulas for the general population. Conclusions The excess cardiovascular risk among patients with SLE varies substantially depending on the SLE-related risk factors, age and traditional risk factors. Cardiovascular risk formulas based on individual data from patients with SLE may better estimate 10-year cardiovascular risk among patients with SLE than the Framingham or American College of Cardiology equations.
KW - cardiovascular
KW - risk assessment
KW - systemic lupus erythematosus (SLE)
UR - http://www.scopus.com/inward/record.url?scp=85073315465&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073315465&partnerID=8YFLogxK
U2 - 10.1136/lupus-2019-000346
DO - 10.1136/lupus-2019-000346
M3 - Article
C2 - 31749976
AN - SCOPUS:85073315465
SN - 2053-8790
VL - 6
JO - Lupus Science and Medicine
JF - Lupus Science and Medicine
IS - 1
M1 - e000346
ER -