New tool best estimates CV risk in people with lupus MedTwitter RheumTwitter
A tool that incorporates lupus-related variables with traditional risk factors provides a much more accurate assessment of cardiovascular risk in patients with, according to data presented at the annual meeting of the Canadian Rheumatology Association.
risk calculator or the Framingham Risk Score have a limited ability to detect the patients with SLE who are most likely to have an event."These risk assessment tools perform poorly in SLE patients because they do not capture SLE-related inflammation," Dr. Choi said. Of several examples, Dr. Choi cited a study showing"seven times more MIs and strokes observed than expected in SLE patients on the basis of the FRS.
In an example of the risk equation, Dr. Choi described a 50-year-old patient with SLE and a 5% 10-year ASCVD risk score, which is low. After adjustment for SLE risks, which included 10 years disease duration, high disease activity, elevated, and positive anti–double stranded DNA status, the 10-year CV risk score climbed to 16.2%, which is moderate.
In predicting CV events, the differences in specificities were in the same general range, although somewhat higher for the ASCVD risk score in regard to predicting MACE and MACE plus secondary events . However, the sensitivities were much higher for SLECRISK relative to the ASCVD risk score for MACE alone and for MACE plus secondary events ., the ASCVD risk score identified 8 patients missed by SLECRISK, whereas SLECRISK identified 89 missed by the ASCVD risk score.
A SLE-specific tool for evaluating CV risk is an important"unmet need," according to Karen H. Costenbader, MD, professor in the division of rheumatology, inflammation, and immunity at Brigham and Women's Hospital and Harvard Medical School, both in Boston. In an interview, she reiterated that measuring CV risk in SLE is already guideline recommended, but conventional tools have been shown to be inaccurate.
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