Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Patients with systemic lupus erythematosus (SLE) develop premature atherosclerosis (AS). This study examines predictive factors at inception for atherosclerotic vascular events (AVE) over a maximum 10 years of followup in a multicenter, international inception cohort.
Methods: An inception cohort of SLE patients from 31 centres from 12 countries has been assembled according to a standardized protocol between 2000 and 2012 to study risk factors for atherosclerosis. At yearly visits demographic and cardiovascular risk factors are collected and vascular events (VE) are described and attributed on a specialized form. Events recorded include myocardial infarction (MI), angina, congestive heart failure (CHF), intermittent claudication (PVD), stroke, and transient ischemic attack (TIA). Diagnosis of an event was confirmed using standard clinical criteria and diagnostic tests where appropriate. Attribution to AS was made by physicians on the basis of lupus disease being inactive at the time of the event, and/or the presence of typical AS changes on imaging or pathology and/or evidence of AS elsewhere. Analysis was done using descriptive statistics and Cox proportional Hazard model.
Results: Of the inception cohort of 1844 SLE patients 93 had VE due to non-AS causes (e.g. active SLE or thrombosis) and 350 patients had only enrolment data leaving 1401 patients. 31 patients had 41subsequent AVE after enrollment. The mean time to AVE or last clinic followup was 5 years. distribution Patients’ race/ethnicity distribution was as follows: 51% Caucasian, 16% Black, 17% Asian 12% Hispanic 4% other. At enrollment risk factors for AS are shown in the table 1.
|
|
Patients without AVE no=1370 |
Patients with AVE n=31 |
P value |
|
Age |
34.6±13.1 |
56.0±13.8 |
<0.0001 |
|
Sex, % |
90.6 |
58.1 |
<0.0001 |
|
Diabetes, % |
3.2 |
10.7 |
0.06 |
|
Framingham risk Score Mod/High, % |
1.5 |
25.0 |
0.001 |
|
Smoker ever, % |
35.7 |
61.3 |
0.004 |
|
Obese, % |
29.3 |
53.6 |
0.01 |
|
Hypertension, % |
32.6 |
60.0 |
0.003 |
|
Hypercholesterolemia, % |
34.7 |
50.0 |
0.12 |
|
Increased LDL*, % |
33.3 |
33.3 |
1.00 |
|
Increased Creatinine, % |
23.5 |
47.8 |
0.01 |
*LDL=low density lipoprotein
Table 2. Time to Event Analysis 1 risk factor at a time
|
|
Hazard Ratio |
95% CI |
p value |
|
One risk factor at a time |
|||
|
Age |
1.09 |
1.07, 1.12 |
<0.0001 |
|
Caucasian |
3.39 |
1.46, 7.87 |
0.005 |
|
Male |
6.30 |
3.09, 12.87 |
<0.0001 |
|
FRS Mod/High |
13.15 |
3.99, 43.22 |
0.0001 |
|
Smoker ever |
2.95 |
1.43, 6.09 |
0.003 |
|
Obesity |
2.92 |
1.39, 6.14 |
0.005 |
|
Hypertension |
3.10 |
1.49, 6,43 |
0.002 |
|
Hypercholesterolemia |
1.85 |
0.90, 3.77 |
0.09 |
|
Stepwise regression with all above variables |
|||
|
Age |
1.09 |
1.06, 1.11 |
<0.0001 |
|
Male |
4.07 |
1.84, 9,04 |
0.0006 |
*FRS=Framingham Risk Score
Conclusion: Only age and male sex remain significant risk factors for AVE in a multivariate analysis of a multicentre inception cohort followed for a mean of 5 years.
Disclosure:
M. B. Urowitz,
None;
D. Ibanez,
None;
D. D. Gladman,
None;
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