Performance of Cardiovascular Risk Equations versus Vascular Ultrasound in Systemic Lupus Erythematosus in a Black African Population

Abstract

Introduction: Cardiovascular risk is increased in systemic lupus erythematosus. Cardiovascular events are the first cause of death in lupus after five years duration. Prevention of cardiovascular events needs a good evaluation of the risk. In this work, we tried to evaluate the performance of conventional and adjusted forms of cardiovascular risk equations to predict high risk in lupus patients, in comparison with carotid ultrasound. Method: We realized a cross-sectional study during the period from 24 August 2017 to 22 November 2018. Consenting patient meeting the 1997 American college of Rheumatology criteria of systemic lupus erythematosus were recruited. The clinical characteristics and the treatment data were informed. Traditional cardiovascular risk factors were also investigated, and the assessment of cardiovascular risk was performed by Framingham and SCORE equations and their modified forms (multiplication by a factor of 1.5). Carotid ultrasound was used to detect atherosclerosis by measuring intima media thickness and searching for carotid plaques. In last, we compared cardiovascular risk levels by equations to results of carotid ultrasound. Statistical analysis and data collection were performed using SPSS 23.0 software. Results: Forty-nine patients with a sex ratio of 0.13 and a mean age of 33.5 (±11.3) years were enrolled. More than half of patients had dyslipidemia. More than 80% of the population were at low cardiovascular risk according to the equations. However, 16% of cases had carotid atherosclerosis. Between 50% and 100% of patients having atherosclerosis were considered at low or moderate risk by equations. The best sensitivity to predict cardiovascular risk was given by modified Framingham (50%). Conclusion: In our study, conventional and modified risk equations had a bad performance to predict cardiovascular risk in systemic lupus erythematosus.