Background Cardiovascular disease (CVD) is a major cause of mortality in systemic lupus erythematosus (SLE). Role of conventional risk scores which look at cardiovascular events, in assessing subclinical atherosclerosis in SLE is not fully established. This study aims to assess performance of QRESEARCH database risk score-3 (QRISK3), systemic coronary risk evaluation (SCORE) and WHO (World Health Organization) CVD scores in subclinical atherosclerosis and determine clinical associations of the same.
Methods This is a single center cross-sectional analytical study which enrolled 79 patients with SLE (without CVD) and 76 healthy controls. Demography, disease activity, autoantibodies, steroid dose were noted. Subclinical atherosclerosis (carotid plaque or abnormal carotid intima media thickness cIMT) and CVD risk (QRISK3, SCORE and WHO scores) were assessed. Agreement between scores was determined using kappa coefficient.
Results Subclinical atherosclerosis was seen in 52% SLE (abnormal cIMT-47% and plaque- 8%) and 53% healthy controls (abnormal cIMT-47% and plaque 12%). Mean age of cohort was 45±6 years, mean SLE duration 96±64 months, SLEDAI 1 ±2.3 and median SLICC ACR DI of 1 (0–2). SCORE, WHO and QRISK3 had sensitivity of 0%, 10% and 28% in detecting subclinical atherosclerosis in SLE, 20%, 22% and 5% in controls while specificity was 0%, 82% and 79% in SLE and 97%, 91% and 100% in controls respectively. Kappa agreement was 0 for SCORE with other scores, between QRISK3 and WHO 68% and 15% for plaque in SLE and controls, 31% for cIMT in SLE and controls respectively. Anticardiolipin IgG (14.6% vs 2.6%) was numerically higher in SLE with atherosclerosis but not statistically significant.
Conclusions Sensitivity of conventional CVD scores in detecting subclinical atherosclerosis was very poor in SLE with QRISK3 and WHO score having good specificity. Hence, until further scores are validated, screening for subclinical atherosclerosis using carotid ultrasound remains gold standard.
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