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SLE linked with increased atherosclerotic risk in early disease stages
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According to findings, systemic lupus erythematosus appears to increase atherosclerotic risk in its early phase, while traditional risk factors have a greater impact on atherosclerosis during the later stages of SLE.
In the study, researchers evaluated 210 women with SLE and 138 healthy controls who were enrolled in the Toronto Risk Factor Study. The Toronto Risk Factor Study began in 1998 and enrolled 250 women with SLE and 250 age-matched, healthy female controls from a family practice clinic. The present study analyzed the initial cohort 15 years later for the incidence of atherosclerotic cardiovascular (CV) events. The following were classified as CV events: angina pectoris; myocardial infarction (MI; fatal or nonfatal); transient ischemic attack (TIA); and stroke (fatal and nonfatal).
Of the 210 patients with SLE and 138 control patients for whom 15-year follow-up data were available, 19.5% of patients with SLE and 6.5% of controls experienced atherosclerotic CV events. Some patients had more than one CV event. Four control group patients had both angina and MI, while one patient with SLE experienced both MI and stroke. In the SLE group, the incidence of CV events was 0.015 events/patient-years, and among controls, the incidence of CV events was 0.004 events/patient years. Patients with SLE had a higher prevalence of coronary artery disease (CAD) vs. controls (15.2% vs. 3.6%). Conversely, there was no statistically significant difference between SLE and control patients for CVD (TIA and stroke: 4.8% vs. 2.2%). Patients with SLE had a mean time to the occurrence of CV events of 8.8 years. There was a statistical difference in the likelihood of CV event development in patients with SLE vs. controls. In an analysis using Kaplan-Meier survival curve, the researchers found patients with SLE consistently had higher rates of CV events, and this disparity increased with longer follow-up.
In the first 8 years of the study, SLE was the most significant predictor of CV events (HR = 2.8; 95% CI, 1.3-6.3). Patients who developed CV events in the second half of the study more frequently experienced hypertension and diabetes. Thirty-one of the patients with SLE died (10 related to CVD) vs. six patients in the control group (none related to CVD).
“SLE-related risk factors drive accelerated atherosclerosis in the early stages of the disease while traditional risk factors, partially attributed to increased cumulative prednisone dose, significantly affect CV risk in later stages,” the researchers wrote. “Thus, as patients survive longer and their disease is better controlled, continued vigilance in monitoring and treating CV risk factors must remain a priority.” -by Jennifer Byrne
Disclosures: The authors report no relevant disclosures.
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