Background and aims Cardiovascular events are the leading cause of death or disability in people with systemic lupus erythematosus (SLE). However, the real mechanism that causes the risk increments for the major adverse cardiovascular events (MACEs) is still not fully understood. The Age-Adjusted Charlson Comorbidity index (ACCI) score is a prognostic classification that was initially developed for a patient who may have a range of co-morbid conditions and has been validated in many clinical settings.

Methods The data for this study were collected from Taiwan’s National Health Institute Research Database (NHIRD) for the years 2004 to 2007, 5998 participants were enrolled. All patients’ sequential clinically diagnosed SLE data were reviewed from 2002 to 2009 in order to determine their MACEs risk by using ACCI score.

Results Cox proportional hazard ratio model showed that AAC score as a continuous variable conferred 25% increased risk of MACE in average for each AAC point starting from zero. And when patients were divided into different groups by AAC scores, patients with AAC score more than 6 conferred an adjusted hazard ratio 4.88 (95% CI 3.84–6.19, p<0.001), compared to those with AAC score 0–1.

Conclusions This is a national cohort study for the evaluation of MACEs for SLE patients. Our results demonstrated that SLE patients with higher ACCI score show significantly higher risk of cardiovascular events and the ACCI score could be applied as an index for MACEs evaluation.