Background/Purpose: Traditional cardiovascular disease (CVD) risk factors increase the risk of thrombotic clinical manifestations in antiphospholipid antibody (aPL)-positive patients.  The prevalence of CVD risk factors has not previously examined in a large cohort of aPL-positive patients. Our objective was to examine the prevalence of CVD risk factors among aPL-positive patients with or without lupus.

Methods: A secure web-based data capture system is used to store patientsÕ clinical and laboratory characteristics in the context of the APS ACTION International Clinical Database and Repository (ÒRegistryÓ), created to study the natural course of persistently aPL-positive patients (according to the Updated Sapporo Classification Criteria) with or without autoimmune disorders over 10 years. Patients with systemic lupus erythematosus (SLE) fulfilled the American College of Rheumatology SLE Classification Criteria. Based on the enrolment data, CVD risk factors included in the analysis were hypertension, diabetes, and hyperlipidemia requiring medications, smoking (ever/current), estrogen use, obesity (BMI>30), family history, and sedentary lifestyle.

Results: As of April 2016, 627 persistently aPL-positive patients were recruited from 24 centers. Fifty-two patients were excluded due to the diagnosis of other systemic autoimmune diseases and 4 patients due to missing data. Of the remaining 571, 124 (21.7%) were asymptomatic carriers. The prevalence of CVD risk factors was not different between aPL-positive patients with or without SLE, except current smoking (15.9% vs 9.2%, p: 0.01) and hypertension (35.5% vs 27.3%, p: 0.05) that were more frequent in SLE patients. In a subgroup analysis of aPL-positive patients with thrombosis, hypertension (44.7% vs 31.5%, p: 0.01), and obesity (26.8% vs 36.8 %, p: 0.05) were significantly higher in those with SLE compared to those without SLE.  Among all patients, thrombotic APS patients had significantly higher frequencies of hypertension, hyperlipidemia, obesity, and sedentary lifestyle compared to those with only obstetric APS and asymptomatic aPL carriers (Table).

Conclusion: The prevalence of CVD risk factors was similar between aPL-positive patients with or without SLE except current hypertension and smoking, supporting the need for awareness for these risk factors in both SLE and non SLE patients. Cardiovascular disease risk factors were more frequent among patients with thrombotic APS than those with only obstetric APS or asymptomatic aPL carriers. This suggests that the physicians should also be vigilant about the CVD risk factors and manage them well in order to decrease the risk of thrombosis in aPL-positive patients.