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Abstract Number: 1794

Unexplained Decline in Rates of Cardiovascular Events in a Large Cohort of SLE Patients

Michelle Petri1 and Laurence S Magder2, 1Johns Hopkins University School of Medicine, Baltimore, MD, 2University of Maryland School of Medicine, Baltimore, MD

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: SLE and cardiovascular disease

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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: We have observed a decline in rates of cardiovascular events in systemic lupus erythamatosus (SLE) pateints in our clinic. In this work presented below, we have quantified the decline in rates and assessed the degree to which the decline could be explained by changes in medication use (greater use of hydroxychoroquine, reduced use of corticosteroids), tighter control of cardiovascular risk factors, or demographic changes in our clinic.

Methods: This analysis is based on retrospective data from the Hopkins Lupus Cohort experience since 1993.  A cardiovascular event (CVE) was defined as the occurrence of a stroke, myocardial infarction (MI),  coronary procedure, incident angina, or claudication.  The analysis was performed based on a data set with one record per patient-month of participation in the Hopkins Lupus Cohort.  Each record contained data regarding the patient’s clinical history up until that time, the most recently measured levels of disease activity, medications taken at that time, and whether a CVE occurred during that month.  Using this file, rates of CVE per person-year of follow-up were calculated for subgroups of follow-up defined by date, medication, disease activity, and demographics.  Multivariable models were fit using pooled logistic regression.

Results:  Table 1 shows the rates of CVE at different periods of time.  The rate of events dropped by approximately 50% after 2010.   Table 2 shows the rates of events by calendar time in strata defined by potentially explanatory variables.  The reduction in CVE rates after 2010 was observed in all strata defined by corticosteroid or hydroxychloroquine use, systolic blood pressure, and lupus disease activity.  Based on a multivariable model, the reduced rates of CVE after 2010 persisted after adjusting simultaneously for age, race, sex, recent systolic blood pressure and serum cholesterol, history of diabetes, smoking, recent SLE disease activity, corticosteroid dose and hydroxychloroquine use (Odds ratio comparing 2010-2014 to previous years: 0.53, 95% confidence interval 0.32, 0.88, p-value=0.015)

Table 1:  Rate of cardiovascular events during cohort participation by year

Calendar Year

Number of Events

Person-years of Follow-up

Rate per 1000 person-yrs

1993-1998

20

2,009

10.0

1999-2004

50

3,742

13.4

2005-2009

51

3,951

12.9

2010+

25

4,108

6.1

Table 2.  Rates of cardiovascular events by period in strata defined by potentially confounding or explanatory variables.

Stratifying Variable

1993-2009

2010-2014

Events

Person-Years

Rate per 1000 person-yrs

Events

Person-years

Rate per 1000 person-yrs

Recent Prednisone use

  None

  1-9

  10-19

  20+

43

28

24

21

4278

2364

1262

571

10.1

11.8

19.0

36.8

10

7

2

2

2043

829

260

96

4.9

9.1

7.7

20.9

Recent Plaquenil use

  No

  Yes

49

67

2981

5493

16.4

12.2

6

18

614

3285

9.8

5.5

Most Recent SBP

  <120

   120-129

  130-139

  140-159

  160+

28

27

20

23

11

3560

1918

1434

1276

302

7.9

14.1

13.9

18.0

36.5

6

8

2

5

3

1755

807

641

500

120

3.4

9.9

3.1

10.0

25.1

Most Recent SLEDAI

  0

  1-2

  3-4

  5+

33

24

27

26

3558

2192

1561

1197

9.3

10.9

17.3

21.7

8

5

3

8

1656

1147

566

454

4.8

4.4

5.3

16.4

Conclusion: The reduced rate of cardiovascular events could not be explained by demographics, medications, cardiovascular risk factors, or lupus-specific variables.  Further work is needed to explain the drop in rates.  Identifying the reason for the drop in rates could have important implications for CVE prevention among SLE patients.


Disclosure: M. Petri, None; L. S. Magder, None.

To cite this abstract in AMA style:

Petri M, Magder LS. Unexplained Decline in Rates of Cardiovascular Events in a Large Cohort of SLE Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/unexplained-decline-in-rates-of-cardiovascular-events-in-a-large-cohort-of-sle-patients/. Accessed February 28, 2021.
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