Comparative Performance of SLECRISK and PREVENT for Cardiovascular Risk Prediction in Systemic Lupus Erythematosus

We compared the predictive performance of SLECRISK, an SLE-specific 10-year cardiovascular (CV) disease risk model, to the new Predicting Risk of Cardiovascular Disease Events (PREVENT) model in our systemic lupus erythematosus (SLE) cohort.

Adults with SLE meeting American College of Rheumatology 1997 and/or European Alliance of Associations for Rheumatology criteria were included. PREVENT and SLECRISK models were used to predict 10-year risk of myocardial infarction, stroke, or cardiac death. Discrimination and model performance were compared.

Among 1243 patients, SLECRISK and PREVENT yielded similar discrimination (area under the curve 0.74 vs 0.76; P = 0.64). Using a 7.5% threshold for predicted 10-year major adverse CV events (MACE) risk, SLECRISK demonstrated higher sensitivity (0.74 vs 0.29), identifying more patients who subsequently developed MACE. By either model, 581 patients (46.7%) were classified as moderate/high risk: 490 by SLECRISK only and 91 by PREVENT only or by both PREVENT and SLECRISK. Patients classified by SLECRISK alone were younger (mean 42.5 vs 57.2 years, P < 0.001) and had lower systolic blood pressure (122.0 vs 145.0 mmHg, P < 0.001) and creatinine (0.91 vs 2.63 mg/dL, P < 0.001), while showing higher prevalence of anti-dsDNA (85.7% vs 73.6%) and anti-RNP (56.1% vs 28.6%).

Although overall discrimination was similar, SLECRISK demonstrated better agreement between predicted and observed CV events and higher sensitivity for identifying patients who developed MACE. In SLE, in which younger patients may develop CV events without many traditional risk factors, failure to identify at-risk individuals may carry greater clinical consequences than overestimating risk. These findings suggest a role for SLECRISK as a disease-specific tool for CV risk stratification in SLE.