THE STATE OF CURRENT MANAGEMENT OF THE HEIGHTENED RISK FOR ATHEROSCLEROTIC CARDIOVASCULAR EVENTS IN AN ESTABLISHED COHORT OF PATIENTS WITH LUPUS ERYTHEMATOSUS

Abstract

AbstractBackgroundPatients with lupus erythematosus (LE) are at a heightened risk for clinical events, chiefly heart attacks and strokes, caused by atherosclerotic cardiovascular disease (ASCVD). We recently proposed new guidelines to categorize levels of risk for future ASCVD events specifically in LE patients, with recommendations for management. Here, we assessed the state of current management of ASCVD event risk in light of these new recommendations.MethodsWe studied our entire UPenn Longitudinal Lupus Cohort of patients with cutaneous LE, without or with concurrent systemic LE, for whom we had full access to medical records (n=370, LE-ASCVD Study Cohort, years 2007-2021).ResultsOf our LE-ASCVD Study Cohort, 336/370 (90.8%) had a designated primary-care physician. By the new guidelines, the most recent plasma LDL cholesterol levels were above goal for 252/370 (68.1%) of the Cohort. Two hundred sixty-six (71.9%) had hypertension, which was under- or un-treated in 198/266 (74.4%). Of current smokers, 51/63 (81.0%) had no documented smoking cessation counseling or referrals. Diabetes was generally well-managed, and hypertriglyceridemia was uncommon. Of the Cohort, 254 patients qualified for two widely used online calculators in primary prevention that estimate the risk of an ASCVD event in the next 10 years: the ACC-ASCVD Risk Estimator Plus and QRisk3. We also stratified these 254 patients into the categories of ASCVD event risk we recently defined specifically for LE. Surprisingly, these three methods for estimating ASCVD event risk showed clinically meaningful agreement for only 100/254 (39.4%), i.e., discordance for over 60% that could affect clinical management. The documented rate of ASCVD events in the first 10 years after enrollment was 22.3% (95% CI 16.9%, 27.4%), indicating a high-risk population despite a preponderance of women and a median age at enrollment of only 47 years.ConclusionCutaneous LE patients are under-treated compared with the new guidelines and, accordingly, they experience a substantial burden of ASCVD events. Moreover, it is unclear how to accurately assess future ASCVD event risk in these patients – except that it is high – and this uncertainty may complicate clinical management. Efforts are underway to improve ASCVD event risk estimation and guideline implementation in lupus patients.