ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 730

Accrual of Atherosclerotic Vascular Events over 10 Years in a Multicentre Inception SLE Cohort

Murray Urowitz1, Dafna D Gladman2, Nicole Anderson2 and Jiandong Su2, 1Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 2University of Toronto, Toronto Western Hospital, Toronto, ON, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Sunday, October 21, 2018

Title: Systemic Lupus Erythematosus – Clinical Poster I: Clinical Manifestations and Comorbidity

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

The prevalence of atherosclerotic vascular events (AVE) in published literature of an inception cohort with SLE is 10%. We aimed to investigate the annual occurrence and the associated factors of AVE in a multinational multiethnic inception cohort of patients with SLE.

Methods: A large 33-centre multinational inception cohort of SLE patients was followed yearly according to a standardized protocol between 2000-2018. Patients entered the cohort within 15 months of SLE diagnosis (≥4 ACR criteria). Patients followed for at least 10 years were identified. AVEs are described and attributed on a specialized form. Diagnosis of AVE is confirmed using standard clinical criteria, relevant laboratory data and imaging. Attribution to atherosclerosis (AS) is made on the basis of SLE being inactive at the time of the event, and/or the presence of typical AS changes on imaging or pathology and/or evidence of AS elsewhere. Analysis included descriptive statistics, rate of AVE’s per 100 patient-years of follow-up and univariable and multivariable models.

Results:

Of the 1847 patients enrolled in the cohort, 659 were followed for a minimum of 10 years (90.1% female, 46.3% Caucasian, 14.0% Black, 17.9% Asian, 18.4% Hispanic and 3.5% other). At enrolment mean age was 33.68 ± 12.75 years and SLEDAI-2K 5.75 ± 5.74. Disease duration at enrolment was 5.55 ± 4.21 months.

The prevalence of AVEs, increases over time and is illustrated in table 1. The rate of AVEs per 100-patient years was 0.34. This was similar to the rate found in the entire cohort (N=1847) of 0.35. Associated univariate risk factors for AVE were older age at enrolment, male sex, Caucasian ethnicity, smoking, hypertension, and high cholesterol (Table 2). In multivariable analyses, associated risk factors for AVE were older age at enrolment [hazard ratio and 95% confidence interval [HR (95%CI)] [1.09 (106, 1.12)], smoking [1.03 (1.00, 1.06)] and steroid use [4.74 (1.08, 20.88)].

Conclusion:

The prevalence of AVE in this study is much lower compared to previously published data. This may be due to more judicious use of glucocorticoids and improvements in treatment of cardiac risk factors. Although only a small number of classic risk factors showed positive associations in multivariable analysis all risk factors should be closely monitored and treated as they are in the general population.

Table 1. Cumulative annual prevalence of AVEs over time (n=659)

Follow-up

AVE

1

3 (0.46%)

2

4 (0.6 %)

3

8 (1.2%)

4

9 (1.3%)

5

11 (1.7%)

6

11 (1.7%)

7

13 (1.9%)

8

15 (2.3%)

9

16 (2.4%)

≥10

28 (4.3%)

Table 2. Univariate analysis of associated factors for AVE

Predictor

Hazard Ratio (95% CI)

p value

Age at enrolment (mean ± SD)

1.09 (10.6, 1.12)

<0.001

Gender (F)

0.24 (0.10, 0.55)

<0.001

Caucasian vs. non-Caucasian

3.81 (1.52, 9.54)

0.004

Follow up years from enrolment to last visit

0.81 (0.65, 1.01)

0.065

Smokers (ever)

2.47 (1.11, 5.49)

0.027

Smoking years *

1.06 (1.04, 1.09)

<0.001

Hypertension*

3.65 (1.09, 12.19)

0.036

Hypertensive years*

1.03 (0.89, 1.20)

0.652

High cholesterol*

8.99 (1.22, 66.38)

0.031

Years with high cholesterol*

1.20 (1.03, 1.39)

0.019

High glucose*

1.68 (0.77, 3.68)

0.196

Years with high glucose*

1.09 (0.78, 1.51)

0.632

Glucocorticoid treatment ever

1.85 (0.82, 4.19)

0.140

Positive anticardiolipin or Lupus anticoagulant*

2.21 (0.52, 9.36)

0.283

Antimalarial treatment ever

0.46 (0.18. 1.14)

0.093

Immunosuppressive treatment ever

0.90 (0.41, 1.98)

0.789

*within 10 years of diagnosis

Disclosure: M. Urowitz, None; D. D. Gladman, Abbvie, Amgen, BMS, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, UCB, 5,Abbvie, Amgen, Celgene, Janssen, Novartis, Pfizer and UCB, 2; N. Anderson, None; J. Su, None.

To cite this abstract in AMA style:

Urowitz M, Gladman DD, Anderson N, Su J. Accrual of Atherosclerotic Vascular Events over 10 Years in a Multicentre Inception SLE Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/accrual-of-atherosclerotic-vascular-events-over-10-years-in-a-multicentre-inception-sle-cohort/. Accessed .

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