Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology. It has been shown that patients with SLE are at a higher risk for premature atherosclerosis because of their disease and its treatment. Hypertension and hypercholesterolemia are treatable risk factors for the prevention of coronary artery disease in these patients.  The purpose of this study was to determine if controlling hypertension and hypercholesterolemia is associated with a decreased rate of atherosclerotic vascular disease in patients with SLE who have been followed prospectively in a long term study.

Methods: SLE patients registered in the Lupus Clinic within 1 year of diagnosis between 1985 and 2002 were studied.  Thirty-one patients with atherosclerotic vascular events (AVEs), defined as myocardial infarction, angina, pacemaker insertion, coronary artery bypass surgery, transient ischemic attack, stroke, or peripheral vascular disease, were identified from the computerized database.  AVEs were subsequently confirmed by a detailed chart review.  Controls, defined as having no history of AVEs, were matched to cases based on age at SLE diagnosis, gender, decade of clinic entry, disease duration at clinic entry, Adjusted Mean SLE Disease Activity Index-2K (AMS) at time of AVE and SLE Disease Activity Index-2K (SLEDAI-2K). Successful control of blood pressure and cholesterol (total and LDL) was determined for patients with AVEs and for those without AVEs.  Successful control was defined as normal levels in 90% of follow-up visits (ie. systolic BP ≤140 mmHg, diastolic BP ≤90 mmHg, serum total cholesterol ≤5.2 mmol/L, serum LDL ≤3.2 mmol/L).  P-values were calculated based on the chi-square test.

Results: 30 patients with AVEs and 60 matched controls without a history of AVEs were included.  Average disease duration at time of AVE for cases was 6.9 ± 4.8 years, and matched disease duration for controls was 6.1 ± 4.2 years (p=0.45). Successful control of hypertension and hypercholesterolemia are shown  in Table 1, according to risk factor profile.

   Table 1.Number of patients with successful control of hypertension and hypercholesterolemia

Risk factor profile		Cases (n=30)	Controls (n=60)	p-value
Hypertension and hypercholesterolemia		17	23
	Both success	2 (12%)	2 (9%)
	BP only success	6 (35%)	3 (13%)	0.08*
	Cholesterol only success	3 (18%)	2 (9%)
	Neither success	6 (35%)	16 (69%)
Hypertension only		8	12
	BP success	2 (25%)	1 (8%)	0.54
	Unsuccessful	6 (75%)	11 (92%)
Hypercholesterolemia only		2	12
	Cholesterol success	1 (50%)	3 (25%)	0.51
	Unsuccessful	1 (50%)	9 (75%)
Neither hypertension nor hypercholesterolemia		3 (10%)	13 (22%)

*Mantel-Haenszel chi-square test where “BP only success” was combined with “Cholesterol only success”

Conclusion: Hypertension and hypercholesterolemia are infrequently controlled in patients with SLE.  Inadequate control of these risk factors is seen in both patients who have had an AVE and those who have not, suggesting that other risk factors or protective factors must play a role in the development of AVEs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/control-of-hypertension-and-hypercholesterolemia-is-not-associated-with-a-decreased-rate-of-atherosclerotic-vascular-events-in-patients-with-systemic-lupus-erythematosus/