Background The first cause of mortality in patients with Systemic Lupus Erythematosus (SLE) is cardiovascular disease (CVD). Accelerated atherosclerosis that occurs in SLE is considered one of the fundamental mechanisms of the increase of cardiovascular mortality in this group of patients. Among the factors that contribute to the accelerated atherosclerosis process, we include the classical CVD risk factors, as well as the inflammatory and specific SLE factors.
Objectives To assess the CVR in SLE patients and the possibility of modifying it based on the accumulative damage and the disease activity.
Methods Cross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, from the Rheumatology Service of Arnau de Vilanova Hospital and La Fe Hospital. All patients had a complete blood-test with autoimmunity markers, and clinical, biometrics and treatment data were collected. Biostatistical analysis was performed with the R software version 3.2.3.
Results 140 patients were evaluated; (95% women) with 33.39±13.63 year-old average at the diagnosis time with a 10.05±11.42 year-evolution of SLE. 15% of patients had had some kind of CVD; in them, we observe an increase of the classical cardiovascular risk factors comparing to the group who hadn't had any CVD manifestation.
We found a statistically significant association between high scores in the SLICC-ACR index (P<0.001), dyslipemia (P=0.04), diabetes (P=0.02) and the presence of CVD in our patients. In addition, though it didn't get statistical significance, we observed a tendency to the association between CVD with the presence of hypertension, high levels of LDL-cholesterol and high scores in the SELENA-SLEDAI activity index.
Finally, and also without statistical significance, we observed a marked difference between levels of IgM anticardiolipin and IgM beta2-glicoprotein, finding higher levels in the group of patients that had suffered any manifestation of CVD.
Conclusions The CVD rate among our group of patients is 15%, clearly higher than the general Spanish population (8.53%). We confirm the weight of classical cardiovascular risk factors as a trigger of CVD in SLE; however, the accumulative damage of the disease calculated with the SLIC-ACR index has a determinant paper in the cardiovascular risk of our patients. Therefor it could be proposed as an additional factor of cardiovascular risk in SLE patients.
On the other hand, the disease activity calculated with the SELENA-SLEDAI index seems to have a tendency of correlation between higher scores and the presence of CVD, though the years of disease evolution don't seem to influence in CVD. Nevertheless, more independent studies are needed to confirm this hypothesis.
Disclosure of Interest None declared