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Cardiovascular risk stratification and appropriate use of statins in patients with systemic lupus erythematosus according to different strategies

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Abstract

Introduction/objectives

Cardiovascular risk management of patients with systemic lupus erythematosus (SLE) is medically relevant. The objectives were to estimate the cardiovascular risk by different strategies in patients with SLE, analyzing which proportion of patients would be candidates to receive statin therapy, and identify how many patients with statin indication received such drugs.

Method

A cross-sectional study was performed from a secondary database. Following the recommendations of National Institute for Health and Care Excellence (NICE) guidelines and the Argentine Consensus, the QRISK-3 and the adjusted Framingham (multiplying factor × 2) scores were calculated in primary prevention subjects. The indications for statin therapy according to these recommendations were analyzed.

Results

In total, 110 patients were included. Regarding patients without previous cardiovascular history, the median adjusted Framingham score was 12.8% (4.1–21.9), and 45.2%, 22.6%, and 32.2% of them were classified at low, moderate, or high risk. The median QRISK-3 score was 6.0% (2.1–14.1) and 42.1% of subjects were classified “at risk”. Only 60% of subjects in secondary prevention received statins, although no patient received the recommended doses. Analyzing patients in primary prevention who did not receive statins (87%), 43.4% and 45.2% of the patients were eligible for statin therapy according to NICE guidelines and Argentine Consensus, respectively.

Conclusions

Our findings showed that a large proportion of patients with SLE have a considerable cardiovascular risk and many of them would be eligible for statin therapy. However, the statin use observed was low.

Key Points

• A large proportion of patients with lupus have a considerable cardiovascular risk, explained in part by dyslipidemia.

• Many patients with SLE would be eligible for statin therapy according to risk stratification based on conventional risk factors.

• The use of statins in this population is inadequate.

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Ethical approval

The study was conducted in compliance with the recommendations for medical research contained in the Declaration of Helsinki, Good Clinical Practice standards, and the applicable ethical regulations. The protocol was reviewed and approved by the Ethical Board of the Institution.

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Authors and Affiliations

  1. Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Ciudad Autónoma de Buenos Aires, Argentina

    Walter Masson, Emiliano Rossi, Lorena M. Mora-Crespo, Guillermo Cornejo-Peña, Carla Pessio, Mariela Gago, Rodolfo N. Alvarado & Marina Scolnik

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  1. Walter Masson
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  2. Emiliano Rossi
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  3. Lorena M. Mora-Crespo
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  4. Guillermo Cornejo-Peña
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  5. Carla Pessio
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  6. Mariela Gago
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  7. Rodolfo N. Alvarado
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  8. Marina Scolnik
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lorena M Mora-Crespo, Guillermo Cornejo-Peña, Carla Pessio, Mariela Gago, and Rodolfo N Alvarado. The first draft of the manuscript was written by Walter Masson and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Walter Masson.

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Masson, W., Rossi, E., Mora-Crespo, L.M. et al. Cardiovascular risk stratification and appropriate use of statins in patients with systemic lupus erythematosus according to different strategies. Clin Rheumatol 39, 455–462 (2020). https://doi.org/10.1007/s10067-019-04856-z

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