Background Arterial vascular events (AVE) are among the major causes of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). Several studies have been carried out to identify the main factors related to AVE in this population. The ankle brachial index (ABI) is one of the tools currently used to identify patients at greater risk of arterial events in the general population; however it has been scarcely studied in patients with SLE.
Objectives The objectives of this prospective cohort study were to determine the predictive value of the ABI for occurrence of AVE in patients with SLE and to identify other possible factors associated with an increased risk of AVE.
Methods 216 patients with SLE were evaluated using an ABI and followed up for 5 years. Pathological ABI is considered an ABI <0.9. Different potential vascular risk factors (traditional, non-traditional and related to SLE and/or the treatments used) were jointly evaluated. AVE: coronary events (angina pectoris, acute myocardial infarction, coronary revascularization by angioplasty or surgery), cerebrovascular events (transient ischemic attack, cerebrovascular accident), peripheral arterial disease (symptomatic intermittent claudication, distal ischemia, revascularization by angioplasty or surgery), and death related to vascular disease. Survival analysis was performed using a competitive risk regression approach, considering non-vascular death as a competitive event, to identify the predictive value of ABI and other factors studied. The Ethical Committee for Clinical Research at Cruces University Hospital approved the study protocol in accordance with the Declaration of Helsinki (CEIC E09/07). All patients signed an informed consent at the time of entry into the study.
Results During follow-up, 4/216 (1.8%) patients were lost to follow-up. 18 AVE were identified in 17 patients, with one patient having 2 episodes of angina requiring angioplasty (4 coronary events, 11 cerebrovascular events, 2 peripheral arterial disease events and 1 sudden death) and 14 deaths (6 per AVE or their sequelae, 4 due to neoplasias and 4 due to cardio-respiratory pathology). In the competitive risk regression analysis, independent predictors of higher risk of AVE were identified: pathological ABI (subhazard ratio (SHR) 3.51, 95% confidence interval 0.96–12.79, p=0.057), family history of AVE (SHR 6.3, 95% CI 1.97–20.21, p=0.002), cumulative total prednisone (grams) (SHR 1.02, 95% CI 1.01–1.04, p=0.004) and a history of arterial thrombosis (SHR 4.60, 95% CI 1.45–14,59, p=0.010).Female gender was a protective factor for the occurrence of AVE (SHR 0.12, 95% CI 0.04–0.40, p<0.0001).
Conclusions Being male, having a higher cumulative dose of prednisone, having a family history of early vascular disease and having suffered previous arterial thrombosis are independent risk predictors of an AVE in patients with SLE. Having abnormal ABI, even without statistical significance, showed a marked tendency to increase this risk despite the low number of events recorded in the studied cohort.
Disclosure of Interest None declared