Assessment of the 2025 EAS clinical staging system for cardiometabolic disorders in systemic lupus erythematosus

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BACKGROUND AND AIMS: Systemic lupus erythematosus (SLE) is an autoimmune disease associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, risk stratification remains an unmet need. In 2025, the European Atherosclerosis Society (EAS) introduced a novel metabolic disorder staging system. This study aimed at assessing the prevalence and prognostic value of metabolic disorders as defined by the EAS 2025 consensus statement in a cohort of SLE patients. METHODS: Consecutive SLE patients who underwent a comprehensive cardiovascular risk assessment between January 2014 and January 2024 at our center were retrospectively included. Data were leveraged to classify patients at baseline according to the EAS 2025 clinical staging system (metabolically healthy, stage 1, stage 2). The risk of incident ASCVD event was compared across these subgroups using log-rank tests and bivariate cox proportional hazard ratio models. RESULTS: A total of 214 SLE patients were included (91 % females, age 44 ± 13 years, SLE duration 13 ± 9 years). Patients were grouped as follows: metabolically healthy (N = 121, 56 %), stage 1 (N = 53, 25 %), stage 2 (N = 40, 19 %). After a median follow-up of 8 [3-10] years, 10 patients (5 %) had an incident ASCVD event. On survival analysis, EAS-based metabolic stages were significantly associated with incident ASCVD events (Log-rank p = 0.001) and remained so after adjustment on age, sex, SLE duration, disease activity index and damage index. CONCLUSIONS: The 2025 EAS clinical staging system has independent prognostic value in predicting incident cardiovascular events in SLE.

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