Background/Purpose: We previously reported the influence of traditional and disease-related risk factors on the development of cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE) followed for 7 years.  The aim of this study was to further investigate their impact on clinical CVD in SLE patients and controls after 15 years of follow-up.

Methods: Two hundred and fifty women with SLE and no prior history of CVD (age 44.5±12 years, disease duration 13.7±9.7 years) and 250 age-matched healthy women (age 44.1±14 years) were recruited between 1998 and 2000. Recorded risk factors at baseline included arterial hypertension, diabetes mellitus, dyslipidemia (total cholesterol, triglycerides, HDL, LDL, VLDL), smoking, family history of premature CVD and body mass index. Patients and controls were prospectively followed for 14±4.1 and 15.9±1.9 years respectively for the development of cardiovascular events (CVEs). CVEs included angina pectoris, myocardial infarction (MI, fatal and non-fatal) transient ischemic attack (TIA), stroke (fatal and non-fatal), and were recorded at clinic visit for patients and by interview and chart review for controls. Statistical software SAS (version 9.3) was used for analysis; p<0.05 was considered significant.

Results: Initial risk factor profile revealed a higher prevalence of arterial hypertension (83/250, 33.2% vs 32/250, 12.8%, p<0.001) and diabetes mellitus (12/250, 4.8% vs 2/250, 0.8%, p=0.007) in patients’ group. The frequency of other variables did not differ significantly. Follow-up data, after 15 years, were available for 211 patients and 137 controls. There were 32 deaths in SLE patients and 7 in controls. CVEs occurred in 32/179 patients (17.9%) and 8/130 controls (6.2%), Table 1. Angina and MI were more common in SLE than controls (17/211, 12.8% vs. 9/137, 6.5%, p=0.005). There were no statistically significant differences for TIA and stroke.

Multivariate Cox-regression analysis demonstrated SLE [HR=2.89, 95% CI 1.22-6.81], family history [HR=2.25, 95% CI 1.13-4.45], triglycerides [HR=1.45, 95 CI 1.03-2.02], 10-year Framingham score [HR=1.12, 95% CI 1.05-1.19] and serum creatinine [HR=1.01 95% CI (1.0-1.02)] to be important predictors for CVEs. Patients with SLE with CVEs compared to those without were older (47.6±9.6 vs. 41.5±10.6 years, p=0.003), had higher serum creatinine (94.7±59.4 vs. 75.4±23.2 μmol/L, p=0.003) and, more frequently, hypertension (43.8% vs. 24.5%, p=0.028), hypercholesterolemia (46.9% vs. 27.9%, p=0.036) and family history of CVD (56.3% vs. 34%, p=0.019). 

Conclusion: SLE patients have a 3-fold increased risk for clinical CVD as compared to healthy controls in the long term. Coronary heart disease was significantly more frequent than cerebrovascular disease. SLE itself, as well as traditional risk factors, are important predictors for CVEs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/initial-risk-factor-profile-and-long-term-cardiovascular-outcome-in-women-with-systemic-lupus-erythematosus/