Comparison of Cardiovascular Risk Scores Performances in a Contemporary Mixed-Ancestry Systemic Lupus Erythematosus Population.

Objective: Cardiovascular disease (CVD) remains the leading cause of mortality in systemic lupus erythematosus (SLE). This study compared the performance of SLE Cardiovascular Risk Equation (SLECRE), Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS), and QRISK3 in estimating CVD risk in a recent and mixed ancestry population of SLE patients (2009-2021). Additionally, a simpler model, the Easy Atherosclerosis Risk Assessment for SLE (EASLE), was proposed.

Methods: A historical analysis of 550 SLE patients with 10-year follow-up in a tertiary hospital was conducted. Traditional and SLE-specific risk factors for CVD were obtained through electronic medical records (2009-2011), and the incidence of cardiovascular (CV) events over the subsequent 10 years (2019-2021) was evaluated. Variables associated with CV events were included in the multiple logistic regression to develop the EASLE. The performances of SLECRE, FRS, mFRS, QRISK3, and EASLE were assessed and compared. Multiple logistic regression was used to develop the EASLE.

Results: Among 550 patients, 34 CVD events were observed (6.2%). Sensitivity and specificity were, respectively, 17.6% and 94.4% in FRS, 58.8% and 84.9% in mFRS, 38.2% and 86.4% in QRISK3, and 91.2% and 22.3% in SLECRE. The areas under the curve were 0.708 for both FRS and mFRS, 0.703 for QRISK3, and 0.553 for SLECRE. The mFRS had the highest balanced accuracy (71.9%). EASLE, with only 3 variables (age, smoking status, and antihypertensive treatment) had 55.9% sensitivity, 86.8% specificity, 71.3% balanced accuracy, and an area under the curve of 0.752.

Conclusions: The mFRS and EASLE exhibited comparable performances and highest balanced accuracies in a recent mixed-ancestry SLE population. EASLE, a simplified tool, offers a promising tool for CVD risk assessment in SLE patients, especially in resource-limited settings.