The challenge of accurate cardiovascular risk assessment in lupus: A comparative analysis

Summary: Abstract Body: Patients with lupus erythematosus (LE) are at an increased risk of clinical events from atherosclerotic cardiovascular disease (ASCVD), yet the accuracy of risk estimation tools in this population remains unclear. Here, we compare the new American Heart Association cardiovascular risk calculator, PREVENT, with the previous ACC ASCVD Risk Estimator Plus (ACC) in a cohort of LE patients, along with investigate the risk of heart failure (HF) estimated by the PREVENT calculator. Utilizing our prospective longitudinal database of patients with LE, we conducted a retrospective chart review to calculate risk scores using both calculators, incorporating optional variables when available. The PREVENT calculator consistently generated far lower estimates of 10-year ASCVD event risk with median risk (2.33% (IQR 0.79%-5.16%)) compared with the ACC calculator (4.65% (IQR 1.30%-11.98%); p<2.2x10-16, Wilcoxon signed-rank), consistent with previous studies. Subtype analyses revealed significant differences between the two calculators for CLE-only patients and for CLE+SLE patients as well (p<2.2x10-16), although no significant difference was observed within PREVENT-generated scores between these subgroups (p=0.11). A strong correlation was identified between the two calculators (p<2.2x10-16). Given literature noting an increased risk of HF in patients with LE, a unique and novel aspect of the PREVENT calculator is the risk calculation for HF (2.01% (IQR 0.59%-5.58%)) and overall cardiovascular disease (3.50% (IQR 1.22%-9.06%)). Given an actual 10-year ASCVD event rate of 13.5% in this cohort (Zhao M et al. 2023), both calculators underestimated risk, with PREVENT underestimating more significantly. These findings highlight the need for caution when using PREVENT in LE populations, because it may be less suitable for certain high-risk patient populations owing to its risk estimates inadequately reflecting their heightened ASCVD risk. This is particularly important for clinical decision-making for LE patients who require tailored risk management strategies. A. On^{1, 2}, X. Yang^{1, 2}, S. Chambers^{1, 2}, H. Ali^{1, 2}, T. Hafshejani^{1, 2}, L. Gomes^{1, 2}, Rui Feng¹, V. Werth^{1, 2}, K. Williams³ 1. UPenn, Phil, PA, United States. 2. CMCVAMC, Phil, PA, United States. 3. Temple, Phil, PA, United States. Clinical Research: Epidemiology and Observational Research