Urowitz Murray B, Ibañez Dominique, Su Jiandong, Gladman Dafna D
From 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.
J Rheumatol. 2016 May;43(5):875-9. doi: 10.3899/jrheum.150983. Epub 2016 Feb 15.
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.
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.
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.
An mFRS in which each item is multiplied by 2 more accurately predicts CAD in patients with SLE.
传统的弗雷明汉风险因素评分（FRS）低估了系统性红斑狼疮（SLE）患者患冠状动脉疾病（CAD）的风险。我们旨在确定对FRS进行调整是否能更准确地反映SLE患者中CAD的较高患病率。
纳入多伦多大学狼疮诊所定期随访的无CAD或糖尿病既往史的SLE患者。通过将各项乘以1.5、2、3或4来计算改良FRS（mFRS）。在研究的第一部分，使用所有符合条件患者的三分之一，我们评估了FRS和mFRS不同乘数的敏感性和特异性。在研究的第二部分，使用其余三分之二符合条件的患者，我们比较了FRS与mFRS的预测能力。在研究的第三部分，我们在对FRS和mFRS的时间依赖性分析中评估了对CAD的预测。
共有905名女性（89.3%），发生了95例CAD事件。在第一部分，我们确定乘以2的乘数提供了敏感性和特异性的最佳组合。在第二部分，根据经典FRS，2.4%的患者被分类为中度/高风险，使用2FRS（乘数为2的FRS）时为17.3%。在第三部分，对首次CAD事件预测的时间依赖性协变量分析显示，经典FRS的风险比（HR）为3.22（p = 0.07），2FRS为4.37（p < 0.0001）。
每项乘以2的mFRS能更准确地预测SLE患者的CAD。
