Use of a strategy based on calculated risk scores in managing cardiovascular risk factors in a large British cohort of patients with systemic lupus erythematosus.
OBJECTIVE
To develop a strategy for stratifying risk of cardiovascular disease (CVD) in a cohort of patients with SLE and to test the usefulness of this strategy in rationalizing management of cardiovascular risk factors.


METHODS
For each patient, data were collected once each year to allow calculation of risk of developing CVD in the next 10 years. Those with risk values >7.5% were considered for intervention to reduce risk. The risk figures and effect of this strategy on management of the cohort as a whole were assessed after 3 years. Patients who had been identified as smokers in 2005 were contacted in 2008 to assess changes in their smoking behaviour.


RESULTS
Over 3 years, 308 patients (>90%) of the cohort had CVD risk assessed at least once. Although 10-year CVD risk exceeded 7.5% in 35 patients, the majority (24) of these had either diabetes mellitus or previous CVD for which established cardiovascular risk reduction protocols already exist. Calculation of risk scores did not alter management in 96.5% of the patients. Ninety percent of the smokers remembered being counselled about smoking in the lupus clinic, 70% had received help to reduce smoking and 47% had either reduced or stopped.


CONCLUSIONS
A protocol mandating regular assessment of cardiovascular risk factors in our lupus clinic resulted in this issue being discussed with >90% of the patients and there was some evidence of an impact on smoking. However, use of these factors to calculate 10-year risk scores did not alter management in over 96% of the cases.
O'Neill
Sean G
SG
Centre for Rheumatology Research, Division of Medicine, University College London, London, UK.
Pego-Reigosa
Jose M
JM
Hingorani
Aroon D
AD
Bessant
Rupa
R
Isenberg
David A
DA
Rahman
Anisur
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D055815:Young Adult