Lupus & antiphospholipid syndrome

Application of EULAR and European Society of Cardiology recommendations with regard to blood pressure and lipid management in antiphospholipid syndrome

RMD OpenPublished Cross-sectional study

Authors' conclusion

Multimodal risk assessment including disease-related and cardiometabolic features used for high-risk diseases such as DM can improve CVR management in APS.

Study context

Population
Patients with antiphospholipid syndrome (APS) without prior atherosclerotic cardiovascular events or diabetes mellitus (DM)
Participants
111 patients
Exposure
Systematic Coronary Risk Evaluation (SCORE), modified-SCORE, DIME and APS-related classifiers vs actual cardiovascular risk (CVR) (European Society of Cardiology (ESC) guidelines) for blood pressure (BP) and lipid treatment eligibility
Outcome
BP and lipid treatment eligibility according to EULAR and ESC recommendations; classification ability (MCC) and agreement (kappa) vs actual CVR
Methodological detailsMatthews' correlation coefficient and Cohen's kappa, actual CVR per ESC guidelines as reference, including carotid/femoral plaque presence
  • Matthews' correlation coefficient and Cohen's kappa
  • Actual CVR per ESC guidelines as reference, including carotid/femoral plaque presence

Main finding

As reported in the abstract

SCORE-guided treatment eligibility vs actual CVR

SCORE underestimated high/very-high AR

>50% of cases

SCORE-guided BP/lipid treatment eligibility, high AR

4.2%/12.6%

SCORE-guided BP/lipid treatment eligibility, very-high AR

10.5%/16.8%

Low-moderate AR cases eligible for lipid-lowering therapy

5.3%

Observational data: associations, not effects.

Further findings

BP treatment: classification ability (Matthews' correlation coefficient (MCC)) and eligibility agreement (kappa)

MCC with DIME, low-moderate risk
0.33
MCC with DIME, very-high risk
0.32
MCC with modified-SCORE+APSevents, high risk
0.25
Kappa with DIME+APSevents or aPLprofile, high risk
0.51
Kappa with DIME, very-high risk
0.31

Lipid treatment: classification ability (MCC) and eligibility agreement (kappa)

MCC/kappa with SCORE (or modified-SCORE)+APSevents, low-moderate risk
0.43/0.41
MCC/kappa with SCORE (or modified-SCORE)+APSevents, very-high risk
0.30/0.30
MCC/kappa with DIME+aPLprofile, high risk
0.50/0.50

Original publication

Application of EULAR and European Society of Cardiology recommendations with regard to blood pressure and lipid management in antiphospholipid syndrome. RMD Open. Published 9 August 2023. doi:10.1136/rmdopen-2023-003326

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