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

OBJECTIVE: We compared the predictive performance of SLECRISK, an SLE-specific 10-year CVD risk model, to the new PREVENT (Predicting Risk of cardiovascular disease EVENT) model in our SLE cohort. METHODS: Adult SLE patients meeting ACR 1997 and/or EULAR 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. RESULTS: Among 1,243 patients, SLECRISK and PREVENT yielded similar discrimination (AUC 0.74 vs. 0.76; p = 0.64). Using a 7.5% threshold for predicted 10-year MACE risk, SLECRISK demonstrated higher sensitivity (0.74 vs. 0.29), identifying more patients who subsequently developed MACE. 581 patients (46.7%) were classified as moderate/high risk by either model: 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 BP (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%). CONCLUSION: Although overall discrimination was similar, SLECRISK demonstrated better agreement between predicted and observed cardiovascular events and higher sensitivity for identifying patients who developed MACE. In SLE, where younger patients may develop cardiovascular 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 diseasespecific tool for cardiovascular risk stratification in SLE.