Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Cardiovascular Disease and Pregnancy
Session Type: Abstract Submissions (ACR)
Background/Purpose: A large multicenter multinational inception cohort was established to study risk factors for atherosclerosis (AS) in SLE. Previous studies have shown a history of cardiovascular events prior to diagnosis of systemic lupus erythematosus (SLE) and rheumatoid arthritis. This study describes the frequency of myocardial infarction (MI) prior to the diagnosis of SLE and within the first 2 years of follow-up.
Methods: An inception cohort of SLE patients from 31 centers in 12 countries has been assembled and followed at yearly intervals according to a standardized protocol between 2000 and 2014. Patients enter the cohort within 15 months of SLE diagnosis (≥4 ACR criteria). MIs were reported and attributed on a specialized vascular event form. MIs were confirmed by one or more of the following: abnormal EKG, typical or atypical symptoms with EKG abnormalities and elevated enzymes (≥2 times ULN), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used.
Results: 31 of 1848 patients that entered the cohort had an MI. Of those, 23 patients had an MI occur prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied 60.3% were female, 82.6% were Caucasian, 4.3% Black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5 ± 15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1 ± 7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up.
Table 1. Cohort Characteristics and CAD risk Factors at Baseline
|
|
Early MI Patients |
Non-early MI Patients |
p |
|
N |
23 |
1825 |
|
|
Sex (female) |
14 (60.9%) |
1626 (89.1%) |
<0.0001 |
|
Age at SLE Diagnosis (years) |
52.5 ±15.0 |
34.5 ± 13.2 |
<0.0001 |
|
SLEDAI-2K |
3.65 ± 3.54 |
5.35 ± 5.39 |
0.03 |
|
Anti-dsDNA
|
7/22 (31.8%) |
650/1661 (39.1%) |
0.48 |
|
Low C3 and C4 |
8/22 (36.4%) |
617/1666 (37.0%) |
0.95 |
|
HsCRP |
3/12 (25%) |
141/742 (19.0%) |
0.60 |
|
ESR |
8/14 (57.1%) |
519/927 (55.9%) |
0.93 |
|
On Steroid |
19 (82.6%) |
1260 (69.1%) |
0.16 |
|
On Antimalarials
|
14 (60.9%) |
1234 (67.8%) |
0.48 |
|
On Immunosuppressives
|
10 (43.5%) |
725 (39.8%) |
0.72 |
|
Family History of MI |
4/9 (44.4%)
|
127/228 (55.7%)
|
0.51
|
|
Hypercholesterolemia |
6 (28.6%)
|
549 (35.7%)
|
0.50
|
|
Hypertension (≥ 140/90) |
7 (30.4%) |
213 (11.9%) |
0.007 |
|
BP Diastolic |
74.2 ± 12.2
|
75.2 ± 11.0
|
0.67
|
|
BP Systolic |
125.8 ± 18.5
|
119.6 ± 16.8
|
0.08
|
|
Diabetes |
1 (4.6%) |
68 (3.8%) |
0.85 |
|
Metabolic Syndrome |
5/19 (26.3%) |
238/1647 (14.5%) |
0.15 |
|
ACL |
1.47 ± 6.06
|
4.23 ± 13.41
|
0.09 |
Risk factors associated with early MI in univariate analysis are male sex, older age at diagnosis, lower SLEDAI-2K and hypertension. In multivariate analysis only age (OR=1.07 95% CI (1.04, 1.10)) and male sex (OR=3.2, 95% CI (0.13, 0.78)) remained significant risk factors.
Conclusion: MI prior to or early in diagnosis of SLE may indicate earlier low grade disease activity not diagnosed or a concomitant alternative predisposition to AS and SLE.
Disclosure:
M. B. Urowitz,
None;
D. D. Gladman,
None;
N. Anderson,
None;
D. Ibanez,
None;
S. L. I. C. C. (SLICC),
None.
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