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Abstract Number: 718

Atherosclerotic Vascular Events in a Multinational SLE Inception Cohort: Description and Predictive Risk Factors over a 17 Year Period

Murray Urowitz1, Dafna D Gladman2, Nicole Anderson3 and Jiandong Su4, 1Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 2Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada, 3Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 4University of Toronto, Toronto Western Hospital, Toronto, ON, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Atherosclerosis and systemic lupus erythematosus (SLE)

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Session Information

Date: Sunday, November 5, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster I: Biomarkers and Outcomes

Session Type: ACR Poster Session A

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

Background/Purpose: A large multicentre multinational inception cohort was established to study risk factors for atherosclerosis (AS) in SLE. We aim to describe all vascular events (VE) and determine the predictors of atherosclerotic vascular events (AVE) in this cohort over a 17 year period.

Methods: Patients enter the cohort within 15 months of SLE diagnosis (≥4 ACR criteria). Clinical and laboratory features of SLE are collected annually in a standardized protocol from 2000-2017.  Patients with <3 years of follow-up or VEs attributed to other causes were excluded. VEs recorded include myocardial infarction (MI), angina, congestive heart failure (CHF), intermittent claudication (PVD), transient ischemic attack (TIA), pacemaker insertion and stroke. Diagnosis of a VE is confirmed using standard clinical criteria, relevant laboratory data and imaging where appropriate. Attribution to AS was made on the basis of lupus disease being inactive at the time of VE, and/or the presence of typical AS changes on imaging or pathology and/or evidence of AS elsewhere.  Factors associated with AVE were analyzed on patients with AVEs that occurred after study enrollment using time to event analysis with time dependent covariates and cox proportional hazard model.

Results: 1848 patients entered the cohort (88.7%F, age at SLE 34.7 ± 13.4 years, disease duration 5.6 ± 4.2 months, mean follow-up of 7.3 ± 4.5 years). Thus far, there have been 231 VEs in 159 patients. These include: MI (24), angina (31), CHF (52), pacemaker insertion (9), PVD (20), TIA (29) and stroke (66). 106 VEs were attributed to active lupus and 42 to other causes.  83 VE in 57 patients were attributed to AS including: MI (17), angina (26), CHF (12), pacemaker (5), PVD (9), TIA (7), and stroke (7). 14 patients in the AS group had >1 AVE. SLE duration at first AVE was 3.7 ± 3.5 years. Of the 57 AVE patients, 47 had an AVE that occurred after study enrollment.

Table 1. Cohort Characteristics at Enrolment

 

Characteristic

Patient that had a AVE (N=47)

Patients that did not have a VE (N=1364)

p value

 

Male

13 (27.7%)

133 (9.8%)

<0.001

 

Caucasian

34 (72.3%)

663 (48.6%)

0.001

 

Age at SLE diagnosis (Mean ± SD)

51.82 ± 14.89

33.99 ± 12.93

<0.001

 

Smoking

25 (53.2%)

466 (34.2%)

<0.001

 

Hypertension

26 (55.3%)

446 (32.7%)

0.001

 

Diabetes

3 (6.7%)

46 (3.4%)

0.241

 

Obese

23 (51.1%)

381 (28.9%)

0.001

 

Hypercholesterolemia

21 (44.7%)

475 (34.8%)

0.165

 

Family history of CAD

21 (45.7%)

300 (22.5%)

0.001

 

SLEDAI-2K  (Mean ± SD)

4.13 ± 4.83

5.38 ± 5.33

0.112

 

Total ACR Criteria (Mean ± SD)

       Serositis

       Renal Disorder

       Neurologic Disorder

       Immunologic Disorder

4.96 ± 1.21

21 (44.7%)

12 (25.5%)

3 (6.4%)

39 (83.0%)

4.91 ± 1.05

367 (26.9%)

389 (28.5%)

55 (4.0%)

1,044 (76.5%)

0.683

0.007

0.655

0.425

0.304

 

Anticardiolipin

7/35 (20.0%)

116/894 (14.5%)

0.198

 

Lupus Anticoagulant

13/35 (37.1%)

187/926 (20.2%)

0.026

 

Treated with oral steroids

32 (68.1%)

928 (69.7%)

0.802

 

Average daily corticosteroid dose (Mean ± SD)

14.20 ± 17.58

16.73 ± 17.39

0.327

 

Treated with antimalarials

26 (55.3%)

936 (68.6%)

0.251

 

Treated with immunosuppressives

18 (38.3%)

542 (39.7%)

0.926

 

Table 2. Predictive Risk Factors – Multivariable Analysis

Predictor

Hazard Ratio

95% Confidence Interval

p value

Age at SLE diagnosis

1.08

1.06, 1.10

<0.001

ACR Criteria – Serositis

2.47

1.34, 4.54

0.003

Antimalarial treatment

0.52

0.28, 0.95

0.033

 The classic risk factors at inception were not predictive, but they do increase over time (Figure 1).

Conclusion: Over the follow-up of an inception cohort with SLE there were 83 AVEs in 57 patients of which 47 occurred after enrollment.  Only older age and serositis are significant risk factors for AVE and antimalarials were protective. However, traditional risk factors increase over time and may have an impact on the development of AVE in the future.

 


Disclosure: M. Urowitz, None; D. D. Gladman, None; N. Anderson, None; J. Su, None.

To cite this abstract in AMA style:

Urowitz M, Gladman DD, Anderson N, Su J. Atherosclerotic Vascular Events in a Multinational SLE Inception Cohort: Description and Predictive Risk Factors over a 17 Year Period [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/atherosclerotic-vascular-events-in-a-multinational-sle-inception-cohort-description-and-predictive-risk-factors-over-a-17-year-period/. Accessed .
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