Role of Plaque in Predicting Cardiovascular Events in Women with Lupus over a 20 Year Followup

Erika Joyce¹, Linda Santelices², Jennifer Mall², Kristy Huysman², Amy Xiaoqin Tang³, Michael Anderson², Jennifer Elliott⁴, Amy H. Kao^5,6 and Susan Manzi², ¹Internal Medicine, Allegheny Health Network, Pittsburgh, PA, ²Medicine, Allegheny Health Network, Pittsburgh, PA, ³Lupus Center of Excellence, Allegheny Health Network Research Institute, Pittsburgh, PA, ⁴Allegheny Health Network, Pittsburgh, PA, ⁵EMD Serono Research & Development Institute, Inc. (a business of Merck KGaA, Darmstadt, Germany), Billerica, MA, ⁶EMD Serono Research & Development Institute, Inc. (a business of Merck KGaA), Billerica, MA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Cardiovascular disease, longitudinal studies, systemic lupus erythematosus (SLE) and women's health

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

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

Background/Purpose: The increased risk of premature cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) patients has been well reported. Multiple series have demonstrated a higher incidence of accelerated subclinical atherosclerosis, carotid plaque formation, as well as myocardial infarction (M.I.) within these patients. Herein we report the 20-year incidence of cardiovascular events within a large prospectively followed single-institution female SLE patient cohort.

Methods: A single institution group of women previously diagnosed with SLE were prospectively followed. Baseline characteristics, including cardiovascular disease (CVD) risk factors (Framingham score, presence of carotid plaque, and carotid intima-media thickness), SLE specific risk factors (SLE diagnosis duration, Systemic Lupus International Collaborating Clinics (SLICC) damage score), and glucocorticoid use duration were collected. The incidence of CVD events (hard events: myocardial infarction (MI), coronary artery bypass graft (CABG), cerebrovascular accident (CVA), percutaneous transluminal coronary angioplasty (PTCA), fatal cardiac arrest ; soft events: transient ischemic attack (TIA), acute heart failure, angina, pulmonary embolus (PE)) were followed. Events and information were collected by chart review, patient interview, or National Death Index causes of death. A cox regression analysis was performed to identify independent risk factors for cardiovascular events (CVE’s).

Results: A total of 289 SLE women were enrolled, 89 were removed from the analysis either due to previous CV events or being lost to follow-up. After a median follow-up of 18 years the overall incidence CVE’s was 109 (hard: 43, soft: 66). Baseline Framingham Score (p=<0.001), carotid IMT (p=0.013), carotid plaque (p= 0.038), SLE disease duration (p=0.002), and glucocorticoid use duration (p=<0.001) significantly predicted an increased incidence of hard CVE’s. The mean time to any first CVE was 9.5 years in patients with baseline carotid plaque versus 12 years in patients without carotid plaque. The mean time to any hard CVE was 6.9 years in patients with baseline carotid plaque versus 11.7 years in patients in patients without carotid plaque.

Conclusion: To the best of our knowledge this data represents the longest follow up of CVE’s in a large female SLE cohort. This data re-affirms the synergistic effect of SLE, carotid plaque, and traditional CV risk factors towards the development of CVE’s.

Disclosure: E. Joyce, None; L. Santelices, None; J. Mall, None; K. Huysman, None; A. X. Tang, None; M. Anderson, None; J. Elliott, None; A. H. Kao, EMD Serono, Inc, 3; S. Manzi, Exagen, 2,Exagen, 5,Exagen, 7,GSK, 5,UCB, 5,AstraZeneca, 6,Lupus Foundation of America, 9,AstraZeneca, 2,Human Genome Sciences/GSK, 2,Amgen, 2,Bristol-Myers Squibb, 2.

To cite this abstract in AMA style:

Joyce E, Santelices L, Mall J, Huysman K, Tang AX, Anderson M, Elliott J, Kao AH, Manzi S. Role of Plaque in Predicting Cardiovascular Events in Women with Lupus over a 20 Year Followup [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/role-of-plaque-in-predicting-cardiovascular-events-in-women-with-lupus-over-a-20-year-followup/. Accessed .

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