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Modified Framingham Risk Score more closely predicted CAD risk in patients with SLE
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A modified Framingham Risk Score, in which each item is multiplied by a factor of 2, was a more accurate predictor of the risk for coronary artery disease in patients with systemic lupus erythematosus, according to researchers from the University of Toronto Lupus Clinic in the Centre for Prognosis Studies in the Rheumatic Diseases at the Toronto Western Hospital, Toronto.
A group of 1,013 patients with systemic lupus erythematosus (SLE) with 22,287 clinical visits were studied. The mean number of patient visits available for analysis was 22, and the mean time to the fist coronary artery disease (CAD) event was 9 years, with a total of 95 CAD events among the cohort. Investigators defined CAD as the occurrence of myocardial infarction, angina or sudden death.
The Framingham Risk Score (FRS) was calculated for each patient, with risk defined as very low, low, moderate or high based on an overall 10-year absolute risk. Patients with very low and low risk were grouped and compared to a combined group of patients with moderate to high risk.
The points were multiplied by 1.5, 2, 3 or 4 for a subset of one-third (n = 335) of the patients, of whom 9.9% (n = 33) developed CAD. Based on which patients were categorized as very low or low risk vs. moderate or high risk, an appropriate moderate or high risk was indicated with a 1.5 multiplier but with low sensitivity. A multiplier of 2 (2FRS) provided appropriate specificity and sensitivity for moderate and high risk for CAD in patients with SLE.
Of the remaining two-thirds of patients, 62 patients had a CAD event and 16 patients were identified as moderate or high risk for CAD based on the unmodified FRS criteria. Using the 2FRS, 117 patients were identified as having a moderate or high risk for CAD.
“It has been shown that the other classic risk factors used in the FRS also contribute to the increase in CAD in patients with SLE,” the researchers wrote. “Changing only the age component of the FRS is probably not sufficient — the contribution of the other factors in the FRS should not be ignored. We propose increasing the point value of each of the variables in the FRS by a constant and using this [modified] mFRS to classify patients with SLE into risk categories.” – by Shirley Pulawski
Disclosure: The University of Toronto Lupus Program is funded in part by the Smythe Foundation, University Health Network, Toronto General Western Research Foundation.
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