Konstantinos Tselios1,2, Dafna D Gladman1,2, Jiandong Su1,2, Olga Ace1,2, Murray B Urowitz3,4. 1. From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada. 2. K. Tselios, MD, PhD, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; J. Su, MB, BSc, Health Care and Outcomes Research, Toronto Western Hospital; O. Ace, MD, University of Toronto Lupus Clinic; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network. 3. From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada. m.urowitz@utoronto.ca. 4. K. Tselios, MD, PhD, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; J. Su, MB, BSc, Health Care and Outcomes Research, Toronto Western Hospital; O. Ace, MD, University of Toronto Lupus Clinic; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network. m.urowitz@utoronto.ca.
Abstract
OBJECTIVE: We previously reported the effect of certain factors on cardiovascular disease (CVD) in 250 women with systemic lupus erythematosus (SLE) followed for 8 years. The aim of this study was to delineate their evolution after 15 years of followup. METHODS: There were 210 women with SLE and 138 age-matched healthy women available for analysis after 15 years. Cardiovascular events (CVE) included angina pectoris, myocardial infarction (fatal and nonfatal), transient ischemic attack, and stroke (fatal and nonfatal). Analysis was performed with SAS 9.3 software; p < 0.05 was considered significant. RESULTS: CVE occurred in 41/210 patients (19.5%) and 9/138 controls (6.5%), most of them in the second part (2008-2015) of the study (24/210, 11.4% vs 17/241, 7.1% in SLE group). Coronary artery disease was more common in patients (32/210, 15.2% vs 5/138, 3.6%, p = 0.0041). There was no significant difference for cerebrovascular disease (10/210, 4.8% vs 3/138, 2.2%, p = 0.213). SLE was the most prominent CVE predictor in the first 8 years (HR 2.8, 95% CI 1.3-6.3). Hypertension and diabetes were more frequent in patients who developed CVE during the second half of the study. Thirty-one deaths occurred in patients with SLE (10 because of CVD) and 6 in controls (none because of CVD). CONCLUSION: The relative importance of atherosclerotic risk factors is significantly differentiated over time in SLE. Disease-related factors seem to dominate CV risk during the early stages while traditional factors, partially related to corticosteroid treatment, play a significant role later in the disease course.
OBJECTIVE: We previously reported the effect of certain factors on cardiovascular disease (CVD) in 250 women with systemic lupus erythematosus (SLE) followed for 8 years. The aim of this study was to delineate their evolution after 15 years of followup. METHODS: There were 210 women with SLE and 138 age-matched healthy women available for analysis after 15 years. Cardiovascular events (CVE) included angina pectoris, myocardial infarction (fatal and nonfatal), transient ischemic attack, and stroke (fatal and nonfatal). Analysis was performed with SAS 9.3 software; p < 0.05 was considered significant. RESULTS: CVE occurred in 41/210 patients (19.5%) and 9/138 controls (6.5%), most of them in the second part (2008-2015) of the study (24/210, 11.4% vs 17/241, 7.1% in SLE group). Coronary artery disease was more common in patients (32/210, 15.2% vs 5/138, 3.6%, p = 0.0041). There was no significant difference for cerebrovascular disease (10/210, 4.8% vs 3/138, 2.2%, p = 0.213). SLE was the most prominent CVE predictor in the first 8 years (HR 2.8, 95% CI 1.3-6.3). Hypertension and diabetes were more frequent in patients who developed CVE during the second half of the study. Thirty-one deaths occurred in patients with SLE (10 because of CVD) and 6 in controls (none because of CVD). CONCLUSION: The relative importance of atherosclerotic risk factors is significantly differentiated over time in SLE. Disease-related factors seem to dominate CV risk during the early stages while traditional factors, partially related to corticosteroid treatment, play a significant role later in the disease course.
Authors: Ola Nived; Ragnar Freyr Ingvarsson; Anna Jöud; Petrus Linge; Helena Tydén; Andreas Jönsen; Anders A Bengtsson Journal: Lupus Sci Med Date: 2020-06