#556 Cardiometabolic risk, evaluation and control in Southeast Asians with lupus nephritis: a cross sectional study

Abstract Background and Aims Lupus nephritis (LN) predicts a nine-fold higher risk of atherosclerotic cardiovascular disease compared to lupus patients without nephritis. Early recognition of cardiometabolic risk in patients with LN can allow risk optimization, such as achieving blood pressure, lipid and diabetes control with lifestyle changes and disease-modifying medications to reduce cardiovascular disease. To identify potential gaps in cardiometabolic risk management, we aimed to evaluate the prevalence of cardiometabolic risk, evaluation and control in LN in real-world practice. Method We performed a cross-sectional study of all patients with biopsy-confirmed LN at the Singapore General Hospital between 2011 and 2022. Demographics, laboratory investigations and medications were obtained from electronic medical records. The prevalence of cardiometabolic risks (age, sex, diabetes mellitus, hypertension, hyperlipidemia, ischemic heart disease [IHD], reduced kidney function [estimated glomerular filtration rate, eGFR <60 ml/min/1.73 m2, urine protein-to-creatinine ratio [UPCR] >0.15 g/g, glucocorticoid use), evaluation (office blood pressure [BP], fasting glucose and lipid and HbA1c) and control at the time of diagnosis in three time periods (2011–2014, 2015–2018 and 2019–2022) were compared. Results Among 326 patients with LN, the median age at diagnosis was 42.0 years (interquartile range: 30.9, 52.7) and 81.6% were female. When categorized by eGFR and UPCR, a quarter (25.8%) were at the highest risk categories for cardiovascular disease (Fig. 1). Table 1 showed that across the three time periods, the prevalence of IHD and traditional cardiometabolic risk factors such as age, male gender, diabetes mellitus and hyperlipidemia were not significantly changed while hypertension reduced in 2019–2022. Systolic BP <120 mmHg was achieved in 20.9% in 2011–2014, 32.7% in 2015–2018 and 25.1% in 2019–2022; while BP <130/80 mmHg was achieved in 31.3%, 42.7% and 40.4%, respectively. The use of BP-lowering therapies and renin-angiotensin system (RAS) inhibitors were lowest in 2019-2022, even among patients with hypertension or BP >130/80 mmHg, and among those with G1–G4 and A2–A3 proteinuria. Lipid evaluation was performed in 75.8%; only 32.0% achieved LDL-cholesterol <2.6 mmol/L. There was no significant change in the prevalence of lipid evaluation or LDL- and HDL-cholesterol levels across the three time periods. Glycemic evaluation was significantly less frequent in 2019–2022 (78.7%) compared to the earlier time periods. Fasting glucose was not significantly different in the three time periods, but HbA1c was lowest in 2019–2022. Conclusion Use of RAS inhibitors was suboptimal despite indications for their use (hypertension or BP >130/80 mmHg and in the presence of G1–G4 and A2–A3 proteinuria), while glycemic evaluation and achievement of BP target (SBP < 120 mmHg) were lower in 2019–2022 compared to 2015–2018. These are areas for improvement in cardiometabolic risk management for patients with LN.