Background Cardiovascular disease remains a major cause of morbidity and mortality in SLE. Despite much research in this area, epidemiologic studies in specific populations are lacking.
Objectives We assessed the rate of a first cardiovascular event (CVE) in a German SLE-cohort over a period of four years and identified associated risk factors.
Methods 200 SLE patients visiting our outpatient clinic were invited for participation in a prospective observational study. Information concerning SLE disease characteristics (medications, disease activity measured by SLAM, traditional cardiovascular risk factors, occurrence of CVE [thrombotic stroke, transient ischemic attack (TIA), myocardial infarction (MI), clinically definite angina pectoris (AP)], was obtained at baseline and every two years during follow up. In addition, B-mode ultrasound was used to assess carotid plaques and intima-media wall thickness (IMT). During the observation period 12 patients died and 17 dropped out. Within this analysis, we only included patients who had no previous history of CVE. Thus, our study cohort consisted of 143 patients [120 female, median age 37.0 (14.0-75.0) years, mean disease duration 10.17.7 years]. Results are reported as odds-ratios (ORs).
Results During a median follow up of 4.04 (2.23-5.93) years, we observed 10 CVEs (6,99%) (rate = 18.4/1,000 person-years [TIA (n=2) 3.67; CI95% [0.92;14.67], stroke (n=3) 5.49; CI95% [1.77;17.03], AP (n=5) 9.23; CI95% [3.84;22.17]. None of the patients developed MI]). CVEs were positively associated with male sex (OR=8.97, adjusted by age, BMI and hypertension; p=0.006), current smoking (OR=8.63;p=0.045), BMI (OR=1.18;p=0.038) and familiar history of CVE (OR=6.29;p=0.011). There was no association between CVE and steroid doses at baseline (OR=0.95;p=0.38), but steroid doses at four years follow up is associated with CVE (OR=1.24 per mg does increase, adjusted by age, sex, BMI and hypertension; p=0.025). There was a trend for increasing IMT and CVE (OR=5.086 per mm increase of IMT; p=0.079).
Conclusions The CVE rate in our cohort (18.4/1000 person-years) is in concordance with the reported increased prevalence of vascular complications in SLE patients in other cohorts [e.g. 14.1/1,000 person-years ]. Consistent with previous reports, we identified some traditional CVE risk factors like male sex . After adjustment for age, there was no association between CVE incidence and either duration of SLE or age at SLE diagnosis. In addition, we did not find an association between SLE disease activity and CVEs. Most interestingly, we observed a dose-dependent increase in CVE rates in patients with higher current steroid doses.
Magder LS, Petri M. Am J Epidemiol. 2012;176(8):708-19.
Urowitz et al., Atherosclerotic Vascular Events in a Multinational Inception Cohort of Systemic Lupus Erythematosus. Arthritis Care Res. 2010;62(6):881-7.
Disclosure of Interest: None Declared