Compared with the QRISK3, the adjusted global antiphospholipid syndrome score (aGAPSS) more accurately predicts risk for adverse cardiovascular events in patients with systemic lupus erythematosus (SLE) with or without secondary antiphospholipid syndrome (SAPS), according to findings published in International Journal of Cardiology.

Researchers conducted a comparative cohort study of 142 patients between the ages of 25 and 85 years with SLE treated at San Giovanni Bosco Hospital in Turin, Italy, from September 2019 to February 2020. The study patients were subdivided into 2 groups: those with SLE without SAPS (76.1%, n=108) and those with SLE and SAPS (23.9%, n=34). Patients in both groups were predominantly women (90.7% in the SLE only group and 64.7% in the SAPS group).

Patients in the SAPS group demonstrated higher incidence of cardiovascular events than the SLE only group. Of the 48 thrombotic events, 33 (68.8%) occurred in the SAPS group and 15 (31.2%) in the SLE only group. Out of 22 arterial events, 19 (86.4%) occurred in the SAPS group and 3 (13.6%) in the SLE only group. Of the 32 venous events, 18 (56.3%) occurred in the SAPS group and 14 (43.8%) in the SLE only group. Additionally, 13 ischemic stroke events and 6 transient ischemic attacks occurred in patients with SAPS while none occurred in patients with SLE only.

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The researchers compared the efficacy of the updated QRISK3 algorithm and aGAPSS in predicting the risk for cardiovascular events for these 2 patient populations. They calculated aGAPSS and QRISK3 scores according to patient chart data at baseline.

Following analysis, the researchers discovered that patients who experienced adverse cerebrovascular or coronary events scored significantly higher on aGAPSS than patients without these events (10.1±6.2 vs 5.8±6.1; P =.007). This association did not occur with QRISK3 (patients with cerebrovascular/coronary events=13.1±8.2 vs patients without events=11±11.4; P >.05). There was a strong correlation with the occurrence of any thrombotic event using aGAPSS, especially in men.

When comparing patients who were antiphospholipid antibody positive (aPL+) and patients who were antiphospholipid antibody negative (aPL-) regardless of diagnosis, only aGAPSS showed statistical significance (aPL+=9.6±6.3 vs aPL-=4.1±5.1; P <.001) for predicting cardiovascular risk.

Limitations of the study include the retrospective study design, the relatively young age of the patient population, and the lack of accounting for the impact of treatment duration and time since diagnosis on results. While women predominated both groups, the SAPS group consisted of more men than the SLE only group.

The study authors concluded, “Despite QRISK3 being more accurate than traditional risk score in predicting [cardiovascular disease] risk in [patients with] SLE, aGAPSS appears to be the most valuable tool for this purpose, both in patients with a [sole] diagnosis of SLE and in those…[with] confirmed diagnosis of APS (SAPS).”


Barinotti A, Radin M, Cecchi I, et al. Assessing the cardiovascular risk in patients with systemic lupus erythematosus: QRISK and GAPSS scores head-to-head. Int J Cardiol. 2022;363:185-189. doi:10.1016/j.ijcard.2022.06.040