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Objectives UK radiologists are advised to report incidental coronary artery calcification (CAC) seen on non-gated thoracic computed tomography (CT). This opportunistic evaluation may facilitate earlier identification of coronary artery disease (CAD), potentially mitigating progression to symptomatic disease. Systemic lupus erythematosus (SLE) has an increased risk of accelerated atherosclerotic CAD. Early recognition, and appropriate initiation of primary prevention medications is crucial to ameliorate this.We aimed to; Identify the burden of CAD on routinely performed thoracic CT scans (CT-CAD); Compare the detection of adverse cardiovascular disease (CVD) risk using CT-CAD to QRISK®3 (a well-established UK CVD risk score); Assess current prescribing of statins for primary prevention in those with abnormal CT-CAD and elevated QRISK®3 scores.Methods We performed a retrospective cross-sectional review of adult SLE patients, without established cardiovascular disease, who had previously undergone routine CT imaging. Demographic and clinical data at the time of scans were extracted from electronic care records. QRISK3 scores were calculated and dichotomised (<10% or >10%). Presence of CAC in the 4 main epicardial vessels was scored in line with guidance. Descriptive statistics were used to report associations between QRISK®3 category, CAC severity and statin use.Results Among 48 patients (85% female, mean BMI 26.6 kg/m 2, mean age at diagnosis 47.3 years, mean age at scan 57.2 years), the majority were Caucasian (89%). Hypertension (33%), chronic kidney disease (15%), and diabetes (4%) were the most common cardiovascular risk factors.Overall, 40% had no detectable CAC, 35% had mild, and 25% had moderate calcification.Of those with QRISK®3> 10%, 64% demonstrated mild or moderate CAC. 7 patients with low QRISK®3 (<10%) showed mild CAC. A substantial proportion of high QRISK®3 and/or CAC abnormal patients were not on statin therapy (see figure 1). SLE manifestations did not differ significantly by QRISK category.Abstract PO:03:081 Figure 1Conclusions In this SLE cohort, opportunistic repurposing of routine imaging for CAD assessment revealed a considerable burden of subclinical atherosclerosis. QRISK®3 appeared to underestimate risk in some patients. The high proportion of untreated high-risk individuals underscores the importance of initiatives such as this to improve primary prevention of cardiovascular disease in SLE.