Detection and modification of risk factors for coronary artery disease in patients with systemic lupus erythematosus: a quality improvement study.

OBJECTIVE: To assess the detection and control of risk factors for atherosclerosis in patients with SLE who subsequently develop acute coronary events.
METHODS: Patients followed at the University of Toronto Lupus Clinic who developed a myocardial infarction (MI) or acute coronary insufficiency (ACI) and who had 2 years of follow-up prior to their event were identified and their case notes reviewed. The management of potentially reversible risk factors in this cohort was assessed.
RESULTS: Twenty-four patients (18 female, 6 male) were studied. The mean age at the coronary event was 50 years and the mean duration of SLE was 13.5 years. Nineteen patients had MI and 5 had ACI. Risk factors identified were hypertension (16), obesity/Cushing's (19), smoking (16), hypercholesterolaemia (11), steroid use (22), hyperglycaemia (4) and cardiac involvement with SLE (4). In the two years prior to the event, hypertension and cardiac involvement were appropriately managed in almost all cases. Sixty percent had attempts made to reduce or stop their steroid therapy. Two of four cases with hyperglycaemia and 5 of 11 patients with hypercholesterolaemia had no appropriate action noted. No smoking advice was recorded, while one obese patient had weight reduction advice recorded.
CONCLUSION: SLE patients who develop coronary events have potentially reversible risk factors prior to the event. Rheumatologists perform well when optimizing the control of SLE, minimizing the steroid dose and managing hypertension. Other risk factors are less favorably managed. Physicians managing lupus patients need to play a primary role in screening for and managing cardiac risk factors.