Article Text

Download PDFPDF

291 Assessment of the QRISK2, QRISK3, SLE cardiovascular risk equation, modified framingham and framingham risk calculators as predictors of cardiovascular disease events in systemic lupus erythematosus
  1. Jagan Sivakumaran1,
  2. Paula Harvey2,
  3. Ahmed Omar1,
  4. Murray B Urowitz3,
  5. Dafna D Gladman3,
  6. Nicole Anderson4,
  7. Jiandong Su4 and
  8. Zahi Touma3
  1. 1University of Toronto
  2. 2Division of Cardiology, Women’s College Hospital
  3. 3Krembil Research Institute, University of Toronto
  4. 4The Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital


Background Systemic lupus erythematosus (SLE) is recognised as an independent risk factor for cardiovascular disease (CVD). This study aimed to determine which cardiovascular risk assessment tool: QRISK2, QRISK3, Framingham (FRS), Modified FRS (mFRS) or SLE Cardiovascular Risk Equation (SLECRE) best predicts CVD in SLE. QRISK3, mFRS and SLECRE are CVD risk assessment instruments considering SLE in risk prognosticating patients.

Methods Single-centre analyses on prospectively collected data of 1887 SLE patients were performed to compute 10 year CVD risk scores for each tool. Tools scores were evaluated against CVD development at or within ten years for cases (CVD events) and controls (no CVD events). For cases, the index date for risk score calculation was chosen 10 years, or as close to 10 years as possible prior to the CVD event. Similarly, for controls, risk scores were calculated as close to 10 years as possible prior to the most recent clinic appointment. Proportions of patients classified as low risk (<10%), median risk (10%–20%) and high risk (>20%) of developing CVD according to each tool were determined. Sensitivity, specificity, positive/negative predictive values and c-statistics of these tools were analysed.

Results 232 total CVD events were seen in the cohort including myocardial infarction, stroke, transient ischemic attack, heart failure and CVD death. QRISK2 and FRS performances were similar, while the QRISK3 and mFRS performances were similar. The SLECRE classified the highest number of patients as median-high risk (table 1). The sensitivities and specificities are as follows for each tool: QRISK2 (19%, 93%), FRS (22%, 93%), mFRS (46%, 83%), QRISK3 (47%, 78%), SLECRE (61%, 63%), respectively. The tools were similar in negative predictive value, ranging from 89% (QRISK2) to 92% (SLECRE). The FRS and mFRS had the greatest c-statistics, both equalling 0.73, demonstrating the greatest predictive accuracy amongst the tools, while the QRISK3 and SLECRE had the lowest (0.67).

Abstract 291 Table 1

Percentage of cases and controls classified as low (<10%), median (10–20%) and high risk of developing CVD according to each CVD risk assessment tool

Conclusions While the mFRS performance was superior to the FRS, the QRISK3 did not outperform the mFRS. Although the SLECRE had the highest sensitivity, it had the lowest specificity, demonstrated by grouping the most cases and controls in the median-high risk category. Several factors are important to consider when deciding which risk assessment tools to utilize clinically: ease of use, sensitivity/specificity, and laboratory data accessibility. Thus, the mFRS continues to be a practical tool with a simple, intuitive scoring system appropriate for the ambulatory clinic setting based on the initial weighting of the FRS while adjusting for SLE.

Funding Source(s): Lupus Foundation of America - Gina M. Finzi Memorial Student Summer Fellowship

Cardiovascular Disease Risk Stratification by Risk Assessment Tool

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.