Background/Purpose . Premature coronary-artery atherosclerosis is a major cause of morbidity and mortality in females with systemic lupus erythematosus (SLE), but little is known about the frequency, extent, risk-factors, and burden of coronary-artery disease in male patients.

Methods . We studied 96 male SLE patients attending our outpatient clinic and 94 healthy males w/o preexisting coronary heart disease, matched by age and race. Patients and controls had a standardized assessment of demographic characteristics and traditional cardiovascular risk factors. In addition, patients had an evaluation of lupus characteristics, medications, and laboratory tests including immunological, extended lipid profile, homocystein, and hsCRP. All patients and healthy controls were screened for coronary-artery calcifications using a 64-slice Multidetector Computed Tomography and the extent of calcification was measured by means of the Agatson score.

Results .  Mean (SD) age of lupus patients and controls was 34.9 (10.5) and 35.3 (9.8) years, respectively. Coronary-calcifications were detected in 18 patients (18.8%) and 7 (7.5%) controls (OR 2.87, 95% CI 1.07-8.53). Median calcium score in patients was 68.75 (4.6-755.6), and 7.7 (1.1-140.2) in controls. Calcifications in lupus patients and controls were detected since age 31-40 and 41-50 years, respectively. In two patients, calcifications were detected within 3 years of diagnosis. Patients had more often hypertension (39% vs 4%, P<0.001) and higher levels of homocysteine (14.4+ 10.1 vs 9.3 + 2.5, P<0.001) than controls.

In comparison to patients w/o calcifications, patients with calcifications were older (32.7 + 9.5 vs 44.8 + 7.9 years, P<0.001), had a wider waist (89.1 + 14.4 vs 96.4 + 13.7 cm, P=0.008), higher systolic blood pressure (114.9 + 9.7 vs 121.7 + 12.0, P=0.02), higher Framingham risk score [2.2(1-17) vs 7.9(1-30), P<0.001] and current smokers (14% vs 39%, P=0.04).  Lupus duration was longer (7.1 + 5.7 vs 13.4 + 9.6 years, P=0.01), had accrued more damage (SDI 1.0 + 1.2 vs 2.3 + 1.6, P=0.002), higher cumulative dose of prednisone [20.1 (0-56.1) vs 49.9(8.5-106.5 grams, P=0.001], and received Azathioprine more often (51% vs 78%, P=0.04).  No difference was observed in lupus activity during the course of the disease, clinical manifestations, autoantibodies, and use of anti-malarials and aspirin.

Logistic regression adjusting by disease duration showed an independent association of age (OR 1.23, 95% CI 1.04-1.45) and SLICC score (OR 3.21, 95% CI 1.31-7.86) with calcifications.

Conclusion .  Coronary-artery calcifications are more common, extensive, and present at younger age in male lupus patients than in the general population. Their association to traditional risk-factors and lupus characteristics, particularly chronic damage, raise the possibility of identifying modifiable risk-factors.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/coronary-artery-atherosclerosis-in-males-with-systemic-lupus-erythematosus/