GAPSS Outperforms QRISK in Assessing Cardiovascular Disease Risk in Patients With SLE

Researchers compared the QRISK3 and the adjusted Global AntiPhospholipid Syndrome Score in patients with systemic lupus erythematosus to assess their risk of developing cardiovascular disease.

A head-to-head comparison of the QRISK3 and adjusted global antiphospholipid syndrome (APS) score (aGAPSS) to assess the risk of cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE) showed that aGAPSS is a superior tool, according to findings published in International Journal of Cardiology.

Researchers compared 2 recently updated measures of CVD risk, including the QRISK3 and aGAPSS. The QRISK3 is a new version of QRISK2, updated to address CVD risk in patients with SLE. The QRISK3 estimates CVD risk of patients aged 25 to 84 years based on factors such as smoking, cholesterol/high-density lipoprotein cholesterol ratio, body mass index (BMI), chronic kidney disease, migraine, presence of SLE, severe mental illness, atypical antipsychotic use, corticosteroid use, erectile dysfunction, and variations in systolic blood pressure. Patients who score 10% or higher are at high CVD risk. The aGAPSS incorporates independent CVD risk factors and antiphospholipid antibodies (aPL) profile. Items used to calculate the aGAPSS included hyperlipidemia, arterial hypertension, anti-cardiolipin (aCL) IgG/IgM, anti-b2glycoprotein I (ab2GPI) IgG/IgM, and lupus anticoagulant. Higher scores correlate to a higher occurrence of APS-related outcomes.

The study cohort included 142 patients with SLE (n=108) or SLE plus secondary APS (SAPS; n=34) who attended an Italian hospital between September 2019 and February 2020. The researchers reviewed charts and collected clinical data needed to calculate QRISK3 and aGAPSS.

Previous CVD events included thrombotic events (n=48), arterial events (n=22), venous events (n=32), and ischemic stroke (n=13). Patients with previous cerebrovascular events (CVE) and/or coronary events had significantly higher aGAPSS compared with those without (10.1±6.2 vs 5.8±6.1, respectively; P =.007). The statistical significance of CVE/coronary events increased with higher aGAPSS. For those with aGAPSS of at least 8, events were reported in 11 of 54 (20.37%)  study patients (P =.03). For those with aGAPSS of at least 9, events were reported in 11 of 49 (22.5%) study patients (P =.01). For those with aGAPSS of at least 10, events were reported in 11 of 48 (22.9%) study patients (P =.008). QRISK3 did not discriminate for the occurrence of a previous cardiovascular event.

A correlation between aGAPSS and the occurrence of any thrombotic event was found in univariate and multivariate analysis (P =.012 and P =.009, respectively). There was no similar correlation using QRISK3. Male sex also correlated positively with the occurrence of any thrombotic event (P =.017 and P =.03 in the univariate and multivariate analyses, respectively).

Patients with a positive aPL profile had significantly higher aGAPSS (aPL+ =9.6±6.3 vs aPL- = 4.1±5.1; P <.001), but not QRISK3.

Limitations of the study included the retrospective design, discrepancy in the ratio between men and women in the 2 groups (the SLE without APS group had a higher proportion of women), inability of the tools to account for disease duration, and a relatively young study population with low rates of traditional risk factors (ie, smoking, BMI>25 kg/m2, diabetes).

The study authors concluded, “Despite QRISK3 being more accurate than traditional risk score in predicting CVD risk in [patients with SLE], aGAPSS appears to be the most valuable tool for this purpose.”


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. Published online June 14, 2022. doi:10.1016/j.ijcard.2022.06.040