And that risk is particularly front-loaded within the first year after diagnosis, as the risk of myocardial infarction can be as high as six-fold.

And I think that's a critical point because historically our focus has been on controlling inflammation and preserving renal function.

But what this consensus and recent updates from the American College of Rheumatology are emphasizing is that we need to simultaneously think about continuous cardiovascular protection.

This is a paradigm shift away from just treating the flare to managing cumulative risk over time.

Now, going back to risk stratification, how are you practically incorporating these lupus-specific enhancers into your clinic? Because we don't yet have a universally adopted modified risk calculator.

That's the challenge.

What I've started doing is using standard tools like ACC risk estimation as a baseline, but then applying a qualitative adjustment.

For example, if a patient has active disease, is on chronic steroids, and has reduced EGFR, I essentially treat them as if they're in a higher risk category, often prompting earlier statin initiation or tighter blood pressure control.