Table 1. Categories of ASCVD event risk for patients with lupus erythematosus, with recommended targets for lipoprotein cholesterol and apolipoprotein B (Reproduced with permission from Keyes et al5).
| Risk category | Risk factors | Target serum levels (mg/dL) | ||
| LDLc | Non-HDLc | ApoB | ||
| Recent recurrent ASCVD events | Any patient with clinically evident ASCVD* who experiences two atherosclerotic vascular events within 2 years despite taking maximally tolerated statin therapy, regardless of other medical conditions | <40 | No explicit recommendations | No explicit recommendations |
| Extreme risk | Patients with LE and clinically evident ASCVD | <55 | <80 | <70 |
| Very high risk | Patients with LE with ≥1 conventional risk factor for ASCVD events†, or evidence of subclinical atherosclerosis on imaging‡, or the presence of certain SLE-specific factors§ | <70 | <100 | <80 |
| High risk | Patients with LE without conventional risk factors for ASCVD events†, evidence of subclinical atherosclerosis on imaging‡ or other comorbidities | <100 | <130 | <90 |
Non-HDLc pertains to a convenient parameter that includes the cholesterol carried by all harmful plasma lipoproteins and is calculated as the total plasma cholesterol concentration minus HDLc.
Clinically evident ASCVD: angina, prior myocardial infarction, atherosclerotic stroke or transient cerebrovascular ischaemic attack, and/or symptomatic peripheral artery disease.
Conventional risk factors for ASCVD events: major risk factors are age (men aged >45 years, women aged >55 years), high LDLc (>160 mg/dL), high non-HDLc (≥190 mg/dL), high plasma apoB (>110 mg/dL), cigarette smoking, hypertension (blood pressure ≥130/80), low HDLc (≤40 mg/dL in men, ≤50 mg/dL in women), family history of premature ASCVD events (age <55 years in first-degree male relative, <65 years in first-degree female relative), stage 3 or 4 chronic kidney disease, diabetes mellitus. Additional risk factors are abdominal obesity, polycystic ovarian syndrome and/or high plasma Lp(a). A calculated 10-year ASCVD event risk of ≥7.5% by the Framingham Risk Score×2 or QRisk3 (if SLE is present) calculator could also be used to reclassify a patient with LE from high to very high risk.
Evidence of subclinical atherosclerosis on imaging can include a non-zero coronary artery calcium score, carotid or femoral plaque on ultrasound, or image-evident plaque on coronary CT angiography.
In LE, certain disease-specific factors, particularly high disease activity, long duration, high cumulative damage, a history of corticosteroid use, the presence of serum antiphospholipid antibodies and lupus nephritis, can also be used to reclassify a patient from high to very high risk.
ApoBapolipoprotein BASCVDatherosclerotic cardiovascular diseaseHDLchigh-density lipoprotein cholesterolLDLclow-density lipoprotein cholesterolLElupus erythematosusLp(a)lipoprotein(a)