Related Experiment Video
Updated: Mar 25, 2026
The bm12 Inducible Model of Systemic Lupus Erythematosus SLE in C57BL/6 Mice
Published on: November 1, 2015
Modified Framingham Risk Factor Score for Systemic Lupus Erythematosus
Murray B Urowitz1, Dominique Ibañez2, Jiandong Su2
1From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.M.B. Urowitz, MD, FRCPC, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; J. Su, MB, BSc University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital. m.urowitz@utoronto.ca.
Insights
A modified Framingham Risk Factor Score (FRS), with each item multiplied by 2, better predicts coronary artery disease (CAD) risk in patients with systemic lupus erythematosus (SLE). This adjusted score, the 2FRS, improves cardiovascular risk assessment for this vulnerable population.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Systemic lupus erythematosus (SLE) is associated with a higher prevalence of coronary artery disease (CAD).
- The traditional Framingham Risk Factor Score (FRS) often underestimates cardiovascular risk in SLE patients.
- Accurate risk stratification is crucial for timely intervention and management of CAD in SLE.
Purpose of the Study:
- To evaluate the accuracy of an adjusted Framingham Risk Factor Score (mFRS) in predicting CAD in patients with SLE.
- To determine the optimal multiplier for an mFRS that best reflects the increased CAD risk in SLE.
- To compare the predictive performance of the modified FRS (mFRS) against the traditional FRS.
Main Methods:
- A cohort of SLE patients without prior CAD or diabetes was analyzed.
- A modified FRS (mFRS) was calculated using multipliers of 1.5, 2, 3, or 4.
- Sensitivity, specificity, and predictive ability of FRS and mFRS were assessed in a time-dependent analysis.
Main Results:
- A multiplier of 2 (resulting in the 2FRS) demonstrated the best sensitivity and specificity.
- The 2FRS classified significantly more SLE patients as moderate/high risk (17.3%) compared to the classic FRS (2.4%).
- Time-dependent analysis showed the 2FRS had a higher hazard ratio (4.37) for predicting CAD events than the classic FRS (3.22).
Conclusions:
- The modified FRS with a multiplier of 2 (2FRS) provides a more accurate prediction of CAD in patients with SLE.
- This adjusted risk score improves cardiovascular risk assessment for individuals with systemic lupus erythematosus.
- Implementing the 2FRS can aid in better identifying SLE patients who require closer monitoring and preventative strategies for CAD.
Objective:
The traditional Framingham Risk Factor Score (FRS) underestimates the risk for coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE). We aimed to determine whether an adjustment to the FRS would more accurately reflect the higher prevalence of CAD among patients with SLE.
Methods:
Patients with SLE without a previous history of CAD or diabetes followed regularly at the University of Toronto Lupus Clinic were included. A modified FRS (mFRS) was calculated by multiplying the items by 1.5, 2, 3, or 4. In the first part of the study, using one-third of all eligible patients, we evaluated the sensitivity and specificity of the FRS and the different multipliers for the mFRS. In the second part of the study, using the remaining 2/3 of the eligible patients, we compared the predictive ability of the FRS to the mFRS. In the third part of the study, we assessed the prediction for CAD in a time-dependent analysis of the FRS and mFRS.
Results:
There were 905 women (89.3%) with a total of 95 CAD events included. In part 1, we determined that a multiplier of 2 provided the best combination of sensitivity and specificity. In part 2, 2.4% of the patients were classified as moderate/high risk based on the classic FRS and 17.3% using the 2FRS (the FRS with a multiplier of 2). In part 3, a time-dependent covariate analysis for the prediction of the first CAD event revealed an HR of 3.22 (p = 0.07) for the classic FRS and 4.37 (p < 0.0001) for the 2FRS.
Conclusion:
An mFRS in which each item is multiplied by 2 more accurately predicts CAD in patients with SLE.
Related Concept Videos
01:12Relative Risk
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT