Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose:
The purpose of this study is to determine the relationship between cumulative corticosteroid dose (CCD) with presence of carotid plaques (CP), total plaque area (TPA) and carotid intima media thickness (CIMT) in a population of women with longstanding systemic lupus erythematosus (SLE).
Methods:
A retrospective cohort study, in which women with SLE followed by the University of Toronto Lupus Clinic and whom had undergone a carotid Doppler were included. Outcome variables looked at were CP, TPA and CIMT. Measured variables included were disease related factors, CCD and traditional atherosclerotic risk factors. Statistical analyses were performed using the SAS software, version 9.3. Depending on the nature of the variable, the appropriate statistical models were used to perform univariate, bivariate (Student’s T-test or Chi-Square or Wilcoxon) and multivariate (logistic or linear regression) analyses. The Baron and Kenny’s procedure was used to assess the mediating effect of CCD and the restricted cubic spline model was used to investigate the possible U-shaped relationship of CCD.
Results:
One hundred and twelve participants were included in this study. All participants were female, their disease duration was 19 (SD=12) years and their baseline characteristics are presented in Table 1. CP was found in 37 % of the participants and the mean CIMT was of 0.611 mm (± SD 0.1). In the univariate regression models CCD significantly predicted presence of CP (P = 0.0106), as well as TPA (P = 0.0062) and CIMT (P = 0.0169). In the multivariate models (Table 2) CCD was not a significant determinant of carotid atherosclerosis. Age, was the most influential variable in all our multivariable regression models. Other predictors were hypertension in the CP model, hypertension and diabetes in the TPA model. CCD was found to mediate the relationship between diabetes and CP as well as between diabetes and TPA. Non-linear relationships were not found between CCD and each of the outcome variables.
Conclusion:
Cumulative corticosteroid dose was not a statistically significant determinant of carotid atherosclerosis in this cohort of SLE patients after adjusting for other relevant clinical variables.
Table 1: Baseline Characteristics
|
Characteristic |
Total Population (N = 112) |
Presence of Carotid Plaque (N = 42) |
Absence of Carotid Plaque (N = 70) |
|
Median (IQR) |
Median (IQR) |
Median (IQR) |
|
|
Age (years)*** |
50.6 (38.9 – 59.8) |
57.8 (53.0 – 65.3) |
44.2 (30.7 – 54.0) |
|
Disease Duration (years) ** |
16.1 (9.1-26.4) |
21.6 (12.2 – 34.8) |
14.2 (7.9 -23.4) |
|
SLICC/ACR SDI * |
1 (0 – 3) |
2 (1 – 4) |
1 (0 -2) |
|
Cumulative Corticosteroid Dose (g)* |
28.73 (5.04 – 64.20) |
45.91 (15.90 – 80.87) |
22.41 (2.77 – 45.08) |
|
BMI (kg/m2) |
23.63 (20.85 – 27.77) |
23.57 (20.72 – 29.05) |
23.74 (20.9 – 27.12) |
|
Total Cholesterol (mmol/L)* |
4.32 (3.87 – 4.79) |
4.42 (4.02 – 4.81) |
4.12 (3.59 – 4.71) |
|
Percentage (%) |
Percentage (%) |
Percentage (%) |
|
|
Diabetes* |
5.4 |
11.9 |
1.4 |
|
Hypertension** |
30.4 |
47.6 |
20.0 |
|
Family History |
55.4 |
63.4 |
51.4 |
|
Post-Menopause*** |
63.4 |
97.6 |
42.9 |
|
Smoking** |
32.1 |
50.0 |
24.1 |
Comparing between groups with and without plaques: *p=0.05 – 0.01, **p=0.01 – 0.0001, ***p<0.0001
Table 2: Multiple Logistic and Linear Regression Models for Carotid Plaques, Total Plaque Area and Carotid Intima Media Thickness
|
CP (logistic regression) |
TPA (linear regression) |
CIMT (linear regression) |
|
|
Risk Factor |
Odds Ratio (95 % CI) |
Parameter Estimate |
Parameter Estimate |
|
Age (years) |
1.099 (1.010 – 1.196)* |
0.0046** |
4.1456*** |
|
SLICC/ACR SDI |
1.257 (0.915 – 1.726) |
0.0103 |
n/a |
|
Disease Duration (years) |
n/a |
-0.0023 |
-1.4795 |
|
Cumulative Corticosteroid Dose (g) |
1.0 (1.0 -1.0) |
0.0000004 |
0.0001274 |
|
BMI (kg/m2) |
0.941 (0.844 – 1.048) |
n/a |
0.01847 |
|
Total Cholesterol (mmol/L) |
2.230 (0.882 – 5.640) |
0.0183 |
n/a |
|
Diabetes |
<0.001 (˂0.001 - ˃999.999) |
-0.2147** |
n/a |
|
Hypertension |
0.177 (0.047 – 0.672)* |
-0.0657* |
-24.7054 |
|
Post-Menopause |
0.136 (0.009 – 2.070) |
0.0133 |
-28.2580 |
|
Smoking |
0.318 (0.094 – 1.077) |
-0.0260 |
n/a |
Only the variables that were significant in the bivariate analysis were included in the final models. *p=0.05 – 0.01, **p=0.01 – 0.0001, ***p<0.0001
Disclosure:
M. Rubino,
None;
E. Aghdassi,
None;
S. Makosso-Kallyth,
None;
S. Morrison,
None;
L. Eder,
None;
P. R. Fortin,
None.
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