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Abstract Number: 1792

Optimal Monitoring for Coronary Heart Disease Risk in Systemic Lupus Erythematosus Patients:  a Systematic Review

Konstantinos Tselios1, Barry J. Sheane2, Dafna Gladman3 and Murray Urowitz3,4, 1Medicine, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 2Rheumatology, St James Hospital, Dublin, Ireland, 3Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 4Rheumatology, U of Toronto, Toronto Western Hospital, Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Heart disease and systemic lupus erythematosus (SLE)

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Session Information

Date: Monday, November 9, 2015

Session Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Premature coronary heart disease (CHD) represents a significant cause of morbidity and mortality in systemic lupus erythematosus (SLE). Several studies have been conducted to identify traditional and disease-related factors that have an impact on the atherosclerotic process, as well as methods to quantify the atherosclerotic burden in subclinical stages. Aim of this systematic review was to identify the minimum investigations to optimally monitor the risk of atherosclerotic CHD in SLE in routine practice.

Methods: An English-restricted systematic literature review was performed, using PRISMA guidelines, through Ovid Medline, Embase and the Cochrane Central databases from inception until the third week of May 2014. Specific search-terms included, among others, “systemic lupus erythematosus”, “atherosclerosis”, “coronary artery disease”, “myocardial ischemia”, “acute coronary syndrome”, “myocardial infarction”, “angina pectoris”. Two independent reviewers assessed all articles (5178 in total); upon disagreement, final decision was reached through discussion with a third reviewer. We finally identified 101 eligible articles, 23 with cardiovascular events (CVEs) and 78 with measures of subclinical atherosclerosis as end-points. The Newcastle-Ottawa scale for observational studies was used for quality assessment (all included studies had ≥6 stars).

Results: Both traditional and disease-specific risk factors were identified with independent predictive ability for clinical CHD. The most consistent traditional factors were age (particularly 48 years or in post-menopausal state), male gender, arterial hypertension, dyslipidemia and smoking. SLE factors most commonly associated with clinical CHD were overall disease activity, cumulative damage, disease duration, antiphospholipid antibodies, high sensitivity C-reactive protein and renal disease. Corticosteroids were linked to increased atherosclerotic risk; anti-malarials were shown to be protective. In regard to imaging techniques, only carotid ultrasonography for the assessment of intima-media thickness and plaque area were shown to independently predict future CVEs in lupus patients. Relative risks for CVEs for each identified risk factor are shown in the table.

 

Parameter

 

Age

Male gender

Hypertension

Dyslipidemia

Smoking

 

RR

1.04-5.1

1.56-6.2

1.05-3.5

TC: 3.9-6.9

TG: 1.15-8

2.2-3.7

 

 

Disease activity

Cumulative damage

Disease duration

Renal disease

aPL

hs-CRP

RR

1.05-1.2

1.3-4.1

1.1-4.5

1.2-6.8

1.74-5.8

1.6-3.4

 

IMT

TPA

 

 

 

 

RR

2.02

4.26-9.55

 

 

 

 

 RR: relative risk, TC: total cholesterol, TG: triglycerides, aPL: antiphospholipid antibodies, IMT: intima-media thickness (carotid artery), TPA: total plaque area (carotid artery)

Conclusion: Premature CHD in lupus patients is multifactorial; modifiable traditional risk factors should be monitored initially and at frequent intervals to ensure prompt management. Disease specific factors play a key role in the atherogenetic process and should also be evaluated on a regular basis. Carotid ultrasonography holds promise in predicting cardiovascular events in SLE and should be performed in selected high-risk patients.


Disclosure: K. Tselios, None; B. J. Sheane, None; D. Gladman, None; M. Urowitz, None.

To cite this abstract in AMA style:

Tselios K, Sheane BJ, Gladman D, Urowitz M. Optimal Monitoring for Coronary Heart Disease Risk in Systemic Lupus Erythematosus Patients:  a Systematic Review [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/optimal-monitoring-for-coronary-heart-disease-risk-in-systemic-lupus-erythematosus-patients-a-systematic-review/. Accessed February 25, 2021.
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