Background Cardiovascular disease (CVD) is a leading cause of mortality in systemic lupus erythematosus (SLE). Traditional CVD risk scores underperform in SLE. Interestingly, a high prevalence of nonspecific ST-T changes (NST-T) has been recently reported in lupus patients1,2. These electrocardiographic findings are known to increase the risk for myocardial infarction, coronary artery disease, CVD, and all-cause mortality3 in the general population, but in SLE this association remains unknown. Therefore, we sought to define the association of NST-T with the modified Framingham Risk Score (mFRS) as a surrogate outcome for CVD4.
Objectives To evaluate if NST-T are associated with higher mFRS in SLE patients without clinical cardiovascular disease.
Methods Adult SLE patients without clinical CVD continuously seen at the Columbia University Lupus Center between April 2016 and January 2017, meeting 1997 American College of Rheumatology classification criteria for SLE were studied. Twelve-lead electrocardiogram (EKG), high sensitivity C-reactive Protein (hsCRP), demographics, disease-specific characteristics, medication use, and CVD risk factors were ascertained. Univariable and multivariable linear regression models were constructed to test the association of NST-T with the mFRS.
Results Seventy-four lupus patients were studied (baseline characteristics in table 1). In univariable analysis, patients with NST-T had a significantly higher mFRS (0.44, p=0.018). There were no confounders identified in the analysis. However after adjusting for variables associated with the mFRS: smoking, diabetes, hsCRP, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI], aspirin use, this association remained statistically significant (0.38, p=0.05). Image 1 shows the association of mFRS with NST-T vs no NST-T.
Conclusions Non Specific ST-T changes are independently associated with a higher mFRS in SLE patients without clinical CVD.
Bourré-Tessier J, Urowitz MB, Pineau CA. et al. Electrocardiographic findings in systemic lupus erythematosus: data from an international inception cohort.Arthritis Care Res (Hoboken). 2015 Jan;67(1):128–35.
Geraldino-Pardilla L,Gartshteyn Y, Piña P, et al.ECG non-specific ST-T and QTc abnormalities in patients with systemic lupus erythematosus compared with rheumatoid arthritis. Lupus Sci Med. 2016 Dec 16;3(1):e000168.
Daviglus ML, Liao Y, Stamler J, et al. Association of Nonspecific Minor ST-T Abnormalities With Cardiovascular Mortality The Chicago Western Electric Study. JAMA. 1999;281(6):530–536.
Urowitz MB, Ibañez D, Gladman DD,et al. Modified Framingham Risk Factor Score for Systemic Lupus Erythematosus. J Rheumatol. 2016 May;43(5):875–9.
Disclosure of Interest None declared
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