Objectives To examine the frequency of cardiovascular events (CVE) and to investigate the main risk factors for atherosclerosis in a large cohort of patients with SLE from Spain (RELESSER Registry)
Methods Design: A national multicenter retrospective study. Patients with SLE (ACR 1997 criteria) from 45 Rheumatology university centers (RELESSER Registry) were enrolled. Protocol: A specific protocol was designed to collect variables. Data were extracted from clinical records. Variables:demographic, comorbidity, clinical, laboratory and treatment information. Outcome: Cardiovascular event after SLE diagnosis. It was defined as the presence of ≥1: 1) ischemic heart disease (myocardial infarction and/or angina pectoris based on clinical and/or electrocardiogram and/or changes in cardiac enzymes and/or coronary angiography diagnosis); 2) cerebral vascular accident (CVA) based on a previous diagnosis or clinical manifestations and/or a image specific procedure and 3)peripheral artery disease supported on a previous diagnosis or clinical manifestations confirmed by image procedure. Statistical analysis: Descriptive. Differences between groups were compared using χ2 test, t-test or Mann-Whitney-U-test. Multiple logistic regression (MLR) analysis of potential CV risk factors was performed.
Results Of the 3,658 SLE patients enrolled in RELESSER, 3,649 (99.7%) had sufficient CVE information available. 269 patients (7.4% [95% CI,6.6-8.3]) suffered 318 CVE after SLE diagnosis. The main characteristics of these patients are shown in table. The average (SD) of age at first CVE from SLE diagnosis was 48.6 (17.1) years and occurred after a median disease duration of 10.4 years after diagnosis. The probability of suffers a first CVE after SLE diagnosis was 1.2% at 1st year, 3.4% at 5th year, 5.7% at 10th, and 9.8% at 15th years. CVA were the most frequent CVE after SLE diagnosis (5.7% [95% CI, 5.0-6.5]) followed by ischemic heart disease (3.8% [95% CI, 3.2-4.4]). Univariate analysis found no association of CVE with a family history of CV disease, methotrexate, hematologic disorders, discoid rash, photosensitivity, oral ulcers, arthritis or positivity of Anti-Sm, anti-Ro, anti-La and anti-RNP. MLR analysis shown a strong association (HR [95% CI], p-value) between CVE and age (1.06[1.04-1.08], p<0.001), hypertension (1.66[1.14-2.42], p=0.009), smoking (1.52[1.07-2.15], p=0.019), diabetes (2.42[1.37-4.28], p=0.002), SELENA-SLEDAI at the last visit (1.07[1.03-1.11], p<0.001), neuropsychiatric lupus (2.12[1.33-3.40], p=0.002), Valvular disease (2.10[1.20-3.72], p=0.011), antiphospholipid antibodies (APA) (1.55[1.23-2.56], p=0.012) and high doses of glucocorticoids (GC): >60mg/d (3.11[1.53-6.29], p=0.012).
Conclusions SLE patients suffer a high prevalence of premature CVE associated with traditional CV risk factors and related to SLE, particularly with activity SLEDAI, neuropsychiatric lupus, valvular disease, APA and high doses of GC.
Acknowledgements This work has been supported by FIS (ISCIII) PI11/02857.Partially supported by GSK, UCB, Roche and Novartis. Dr. Pego-Reigosa receives support from Biocaps (grant 316265) of the 7th Framework Programme of the European Union.
Disclosure of Interest S. Manrique-Arija: None declared, A. Fernandez-Nebro: None declared, Í. Rua-Figueroa: None declared, J. Lopez-Longo: None declared, J. Calvo-Alén: None declared, M. Galindo: None declared, J. Pego-Reigosa Grant/research support from: Biocaps