Murray B Urowitz1, Dafna D Gladman1, Vernon Farewell2, Jiandong Su1, Juanita Romero-Diaz3, Sang-Cheol Bae4, Paul R Fortin5, Jorge Sanchez-Guerrero1, Ann Elaine Clarke6, Sasha Bernatsky7, Caroline Gordon8, John G Hanly9, Daniel J Wallace10, David A Isenberg11, Anisur Rahman11, Joan T Merrill12, Ellen Ginzler13, Graciela S Alarcón14, W Winn Chatham14, Michelle A Petri15, Ian N Bruce16, Munther A Khamashta17, Cynthia Aranow18, Mary Anne Dooley19, Susan Manzi20, Rosalind Ramsey-Goldman21, Ola Nived22, Andreas Jönsen22, Kristján Steinsson23, Asad A Zoma24, Guillermo Ruiz-Irastorza25, S Sam Lim26, Kenneth C Kalunian27, Murat Ỉnanç28, Ronald van Vollenhoven29, Manuel Ramos-Casals30, Diane L Kamen31, Soren Jacobsen32, Christine A Peschken33, Anca Askanase34, Thomas Stoll35. 1. Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada. 2. Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. 3. Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. 4. Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. 5. Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada. 6. University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada. 7. Montreal General Hospital and McGill University Health Centre, Montreal, Quebec, Canada. 8. University of Birmingham College of Medical and Dental Sciences, Birmingham, UK. 9. Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. 10. Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles. 11. University College, London, UK. 12. Oklahoma Medical Research Foundation, Oklahoma City. 13. SUNY Downstate Medical Center, Brooklyn, New York. 14. University of Alabama at Birmingham. 15. Johns Hopkins University School of Medicine, Baltimore, Maryland. 16. Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. 17. St Thomas' Hospital and King's College London School of Medicine, London, UK. 18. Feinstein Institute for Medical Research, Manhasset, New York. 19. University of North Carolina, Chapel Hill. 20. Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania. 21. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 22. Lund University and Skåne University Hospital, Lund, Sweden. 23. Fossvogur Landspitali University Hospital Center for Rheumatology Research, Reykjavik, Iceland. 24. Hairmyres Hospital, East Kilbride, Scotland, UK. 25. Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain. 26. Emory University School of Medicine, Atlanta, Georgia. 27. University of California San Diego School of Medicine, La Jolla. 28. Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. 29. Amsterdam University Medical Centers, Amsterdam, Holland. 30. Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic, Barcelona, Spain. 31. Medical University of South Carolina, Charleston. 32. Copenhagen Lupus and Vasculitis Clinic and Copenhagen University Hospital, Copenhagen, Denmark. 33. University of Manitoba, Winnipeg, Manitoba, Canada. 34. Hospital for Joint Diseases, New York University, New York, New York. 35. Kantonsspital, Schaffhausen, Switzerland.
Abstract
OBJECTIVE: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. METHODS: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. RESULTS: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32-0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55-10.30]) and a body mass index of >40 kg/m2 (HR 2.74 [95% CI 1.04-7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17-9.27], P < 0.001). CONCLUSION: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.
OBJECTIVE: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. METHODS: A large 33-center cohort of SLEpatients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. RESULTS: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32-0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55-10.30]) and a body mass index of >40 kg/m2 (HR 2.74 [95% CI 1.04-7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17-9.27], P < 0.001). CONCLUSION: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.
Authors: John G Hanly; Caroline Gordon; Sang-Cheol Bae; Juanita Romero-Diaz; Jorge Sanchez-Guerrero; Sasha Bernatsky; Ann E Clarke; Daniel J Wallace; David A Isenberg; Anisur Rahman; Joan T Merrill; Paul R Fortin; Dafna D Gladman; Murray B Urowitz; Ian N Bruce; Michelle Petri; Ellen M Ginzler; M A Dooley; Rosalind Ramsey-Goldman; Susan Manzi; Andreas Jonsen; Graciela S Alarcón; Ronald F van Vollenhoven; Cynthia Aranow; Meggan Mackay; Guillermo Ruiz-Irastorza; S Sam Lim; Murat Inanc; Kenneth C Kalunian; Soren Jacobsen; Christine A Peschken; Diane L Kamen; Anca Askanase; Vernon Farewell Journal: Arthritis Rheumatol Date: 2021-10-29 Impact factor: 15.483