AB0656 PERFORMANCE OF CONVENTIONAL CARDIOVASCULAR RISK SCORES IN IDENTIFYING SUBCLINICAL ATHEROSCLEROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

BackgroundCardiovascular disease (CVD) is a major cause of mortality in systemic lupus erythematosus (SLE) with a standardized mortality ratio of 2.4, that is underestimated by conventional CVD risk scores. Subclinical atherosclerosis, a major predictor of cardiovascular morbidity is an important target for primary prevention. Carotid intima media thickness (cIMT) and plaques are frequently used measures of subclinical atherosclerosis. Role of conventional risk scores which look at cardiovascular events, in assessment and risk stratification of subclinical atherosclerosis in SLE is not fully established.ObjectivesAssess performance of QRESEARCH database risk score-3 (QRISK3), systemic coronary risk evaluation (SCORE) and WHO (World Health Organization) CVD risk scores in assessing subclinical atherosclerosis in SLE and healthy controls.Compare SLE disease parameters between those with and without subclinical atherosclerosis.MethodsThis is a single centre cross-sectional analytical study. 79 patients with SLE without CVD and 76 age and gender matched healthy controls were enrolled. Demography, disease activity indices, autoantibodies, steroid dose were noted. Subclinical atherosclerosis (any carotid plaque or abnormal cIMT) was assessed. CVD risk was calculated by QRISK3, SCORE and WHO scores. Sensitivity, specificity, positive and negative predictive values were assessed. Agreement between scores was determined using kappa coefficient. Presence of subclinical atherosclerosis was compared with SLE disease manifestations.ResultsSubclinical atherosclerosis was seen in 52% of SLE (abnormal cIMT in 47% and carotid plaque in 8%) and 53% of healthy controls (abnormal cIMT in 47% and plaque 12%). Mean age of SLE and controls was 45±6 and 46±6 years respectively with 99% females. Average SLE duration was 96±64 months, SLEDAI was 1 ±2.3 and median SLICC ACR DI was 1 (0-2). SCORE, WHO and QRISK3 had a 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 others, 31% between QRISK3 and WHO 68% for plaque and 31% for cIMT in SLE. In healthy controls Kappa agreement was 0 for SCORE with others, 0 between QRISK 3 and WHO 15% for plaque and 31% for cIMT. SLE disease parameters were comparable among those with and without subclinical atherosclerosis. Anticardiolipin IgG (14.6% vs 2.6%) and any APLA positivity (41.5% vs 21%) were numerically higher in SLE with atherosclerosis but not statistically significant (p >0.05).ConclusionSensitivity 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.Table 1.Comparison of disease parameters among SLE patients with and without Subclinical AtherosclerosisSC Atherosclerosis n=41No SC atherosclerosis n=38P ValueAge years (Mean± SD)42±645±6.10.38Anti ACLA IgG n(%)6(14.6)1(2.6)0.07Any APLA positive n(%)17(41.5)8(21)0.9Disease duration months (Mean± SD)92±57101±710.77Clinical SLEDAI (Mean± SD)0.5±1.40.7±1.80.33SLICC ACR DI (Median + IQR)0(0-1)0(0-1)0.46Standardized steroid dose mg (Mean±SD)183±70161±810.20SCORE (Median + IQR)0(0-2)0(0-2)0.86WHO (Mean± SD)2.56±1.62.86±20.85QRISK 3(Mean± SD)7.7±3.68.4±60.33SC- subclinicalFigure 1.Sensitivity, specificity, positive and negative predictive values of scores in SLE and controlDisclosure of InterestsNone declared