Background/Purpose:

Patients with systemic lupus erythematosus (SLE) have increased rates of cardiovascular (CV) events that are one of the major causes of mortality. In addition to the traditional CV risk factors, disease related features may contribute to accelerated atherosclerosis. The metabolic syndrome (MetS),  defined by  clustering of  traditional CV risk factors, is reported to be increased in SLE. The aim of this study was to determine  the prevalence  of MetS and CV events in  SLE patients and to study the link between these and  SLE related factors.

Methods: Data of 311 SLE patients attending to the lupus clinic and fulfilling ACR classification criteria were collected from the records including demographic and clinical features, history of CV diseases and phenotype and characteristics of MetS as defined by the National Cholesterol Educational Programme Adult Treatment Panel III ( NCEP ATP III). CV events were defined as documented coronary artery disease and cerebrovascular disease including myocardial infarction and stroke. Association with  clinical features, disease duration, SLICC damage index and treatment of SLE were assessed in patients with MetS and without MetS.

Results:

The mean age of the patients was 40,2± 13,4 years and (89%) were female. The mean disease duration was 112,5 ±84 months, and the mean SLICC damage score was 1,05 ± 1,5. Coronary artery disease was present in 11.1% and cerebrovascular disease was in 5.4%. The prevalence of cardiovascular events was 15.2% and of MetS was 19%.  The most frequent and the least frequent criteria of MetS in SLE patients were abdominal obesity (%51,2) and hyperglycemia (%10,3) respectively. Comparing SLE patients with MetS and without MetS, age (p=0,001), cumulative damage (p<0,001), disease duration (p=0,026) and CV events (p=0,001) were associated significantly with MetS. SLE disease features and treatment modalities were not associated with MetS. CV events were related to disease duration (p=0,05), damage (p<0,001), pericarditis (p<0,001), hematologic involvement (p=0,006), lymphopenia (p<0,001), thrombocytopenia (p=0,002), neurological involvement (p<0,001) and  antiphospholipid (APL) antibody positivity (p=0,008). No relationship was found between  immunosuppressive drug usage or high dose corticosteroid treatment with CV events, whereas HCQ use was found protective   [p= 0,005; OR: 0,32 (0,15-0,69)].

Conclusion:

In SLE patients mainly consisted of young females, the prevalance of MetS was  19% and CV events was 15.2%. Mets was associated with CV events, age, disease duration and cumulative damage whereas clinical and serological features of SLE and treatment were not related to MetS. CV events was also associated with disease duration, organ damage, pericarditis, hematological involvement, neurological involvement and the presence of APL antibodies. There was a significant  protective effect of HCQ from CV events in SLE. The prevention of MetS and long term use of HCQ are warranted to improve prognosis in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/metabolic-syndrome-is-not-only-a-risk-factor-for-cardiovascular-events-in-systemic-lupus-erythematosus-but-also-associated-with-cumulative-organ-damage-a-cross-sectional-analysis-of-311-patients/