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The role of cardiovascular disease risk assessed by ASCVD score in primary thrombosis prophylaxis strategy among antiphospholipid antibody carriers

Sir, Anti-phospholipid syndrome is an autoimmune pro-thrombotic condition that can have devastating effects on patients and their families. The presence of antiphospholipid antibodies (aPL) does not always lead to thromboembolic events. Current consensus recommends maximizing control of cardiovascular disease (CVD) risk in aPL carriers. However, the exact role of quantified CVD risk in thrombogenesis among aPL carriers has not be evaluated. The Atherosclerotic CVD 10-Year Risk (ASCVD) score is a convenient tool designed to determine the absolute CVD risks among healthy individuals and to guide primary prevention. Our study aims to evaluate the role of quantified CVD risk in thrombosis risk stratification among ethnically diverse aPL positive carriers. This study included a convenience sample of 147 patients with persistent high titer ( 99 percentiles) criteria aPL or positive lupus anticoagulant (LA) who attended University of Texas Southwestern Medical Center clinics from 2000–2017 (Table 1). Persistent positive aPL is defined by having at least one positive test at 99th percentile cut-off values at two time points. The 99th percentile cut-off values for aPL were established using 110 healthy controls. Cut-off values for anti-cardiolipin IgG/ IgM are >40 GPL/>40 MPL and for anti-b2 Glycoprotein-I IgG/IgM are >16GPL/>14MPL. Testing of aPL was performed using FDA approved commercial kits. Lupus anticoagulant (LA) was tested by dilute Russell’s viper venom time, partial thromboplastin time–LA and silica clotting time, with appropriate cut-offs established in the laboratory. ASCVD was calculated based on the patient’s age, sex, race, total cholesterol, HDL, most recently documented systolic blood pressure, hypertension treatment, diabetes status, and smoking status. Pearson’s Chi-squared analysis was used to determine the association between increased ASCVD> 7.5% or increased ASCVD> 10% and various thromboembolic events. Non-parametric comparison of ASCVD as a continuous variable was performed among different groups using the Mann–Whitney test. Significantly higher 10-year CVD risk was seen among aPL patients with arterial thrombosis compared to asymptomatic carriers (P1⁄4 0.0063). When comparing thrombotic APS patients to asymptomatic aPL positive carriers, 10-year CVD risk> 7.5% (odds ratio (OR)1⁄4 2.579, 95% confidence interval (CI) 1.063–6.595, P1⁄4 0.036) and 10-year CVD risk> 10% (OR1⁄4 2.902, 95% CI 1.207-7.075, P1⁄4 0.017) were significantly associated with arterial thrombosis but not venous thrombosis or any thrombosis. There were no significant CVD risk differences observed between aPL patients with venous thrombosis/or any thrombosis and asymptomatic carriers. Of those aPL carriers with a 10-year CVD risk >10%, 33.9% were on aspirin. Of those aPL carriers with a 10-year CVD risk> 7.5%, 40.8% were on a statin.