Heart Disease Risk Assessment Tools May Fall Short for People with Lupus
Tools used commonly by clinicians to assess cardiovascular or heart disease risk were found to be only somewhat effective in predicting risk in people with lupus. Researchers compared how well five different assessment tools predicted CVD in people with lupus – including two tools that take lupus diagnosis into account when calculating risk. They found that all tools had limitations, suggesting new assessment tools must be developed, or existing tools require improvements. Lupus warriors are at higher risk for heart problems, such as heart attacks and cardiovascular disease. Lupus can cause blockages in heart arteries, leakage of heart valves, irritation of the outer layer of the heart, and even heart failure.
A group of 1,887 people with lupus were monitored for cardiovascular disease (CVD) development. Study participants risk was evaluated using five tools: QRISK2, QRISK3, Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS), and SLE Cardiovascular Risk Equation (SLECRE). The mFRS and SLECRE tools both take lupus diagnosis into account when calculating CVD risk. The sensitivity, specificity, and predictive value of each tool was noted. During the study, 232 participants experienced a CVD event.
The tools produced disagreeing classification results. When modified for lupus consideration, the risk tools did calculate relatively higher risk scores than those that did not; however, the adjustment did not result in notably improved prediction of CVD. The mFRS tool performed better than FRS, and the researchers concluded it was a practical tool with a simple, easy-to-use scoring system that works well in many clinical settings. However, the QRISK tools were better able to classify risk than mFRS. The SLECRE tool was able to identify the highest number of people at increased CVD risk, but it ultimately did not improve CVD prediction. The investigators encourage further research to determine better heart risk prediction tools for people with lupus.
The Lupus Foundation of America supported this research. Lead researcher, Jagan Sivakumaran, is a 2018 Gina M. Finzi Student Fellowship recipient. Learn more about the impact of lupus on heart health.