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  • O26 First investigation of the performance of validated cardiovascular risk scores in a global (UK/USA) cohort of children, adolescents, and young adults with juvenile-onset systemic lupus erythematosus

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O26 First investigation of the performance of validated cardiovascular risk scores in a global (UK/USA) cohort of children, adolescents, and young adults with juvenile-onset systemic lupus erythematosus
  1. Yiming Gao1,
  2. Misato Niwa1,
  3. Junjie Peng2,
  4. Stacy P Ardoin3,
  5. Laura E Schanberg4,
  6. Laura Lewandowski5,
  7. George Robinson2,
  8. Elizabeth Jury6 and
  9. Coziana Ciurtin2
  1. 1Faculty of Medical Sciences, University College London, London, UK
  2. 2Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, UK
  3. 3Dept. of Pediatrics, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio, USA
  4. 4Duke Clinical Research Institute, Dept. of Pediatrics, Duke University School of Medicine, Durham, USA
  5. 5Lupus Genomics and Global Health Disparities Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, USA
  6. 6Centre for Rheumatology Research, Division of Medicine, University College London, London, UK

Abstract

Objective Juvenile systemic lupus erythematosus (JSLE) is associated with increased cardiovascular disease (CVD)-risk from early in life. This is the first global (UK/US) JSLE study aiming to investigate the performance of CVD-risk scores.

Methods Patient data/CVD-risk factors/JSLE characteristics were collected from two JSLE cohorts: UK/UCL (N=109) and US/APPLE (Atherosclerosis Prevention in Pediatric Lupus Erythematosus) trial (N=120) cohorts, stratified using cross-validated metabolomic signatures (Nightingale) of CIMT (carotid intima-media thickness) progression. QRISK3, Framingham (FRS), Atherosclerotic Cardiovascular Disease (ASCVD) and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores have been calculated/assessed for performance against robust CVD-risk stratification. We used descriptive statistics/correlation/ROC/linear regression analyses.

Results Mean patient age/disease duration for the UCL/APPLE cohorts were 26 ± 4.18 years/13.5± 4.71 years, and 15.60 ± 2.67 years/2.46± 2.44 years, respectively (P<0.001). QRISK3/FRS/ASCVD and PDAY scores classified 6.4%, 0%, 0% and 43.5% as high, and 1.8%, 0%, 1.6% and 21.8% as moderate risk, respectively, in the UCL cohort, while 22.4% and 48.5% were stratified as high and moderate risk, respectively using a validated CVD-risk metabolomic signatures. In the APPLE cohort only 1%, 0%, 0% and 3% patients were classified as high, and 2%, 0%, 4% and 10% as moderate risk by each of the scores above, despite CIMT (the best predictor of CVD) identifying 29.1% as high and 42.4% as moderate CVD-risk. PDAY-score had 60% sensitivity for high and 58% specificity for moderate risk stratification in the UCL cohort, while all the other scores failed to identify patients at risk. PDAY-score correlated with patients’ age/disease duration/median SLEDAI/SLICC scores (r=0.78, 0.48, 0.28 and 0.3, respectively, P<0.05). Linear regression analysis found that age/disease activity were the strongest determinants of PDAY-score (one year increase in age/one point increase in median SLEDAI were associated with 1.13/0.41 points increase in PDAY-score, respectively, when sex/disease duration/damage/lipids/steroids were accounted for).

Conclusions CVD-risk scores, even if validated from age 14, do not adequately capture CVD-risk in JSLE. PDAY-score had moderate performance for young adults only, highlighting the need for better CVD-risk stratification tools in JSLE. Overall disease activity/patient age were the strongest predictors of PDAY-score but only in older JSLE patients.

Acknowledgements This work has been funded by grants from Lupus Research Alliance, USa and Versus Arthritis, UK.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.36

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