Frequency of cardiovascular events in patients with systemic lupus erythematosus. RELESSAR record data
Abstract
Introduction: progress in treatments for systemic lupus erythematosus (SLE) has resulted in a decrease in mortality; however, cardiovascular and infectious diseases remain the leading causes of death. Evidence supports the involvement of the immune system in the generation of atherosclerotic plaque, as well as its connection to autoimmune diseases. Objectives: to describe the frequency of cardiovascular disease (CVD) in the crosssectional RELESSAR registry, as well as its associated variables. Materials and methods: a descriptive and cross-sectional study was performed using patients admitted to the cross-sectional RELESSAR registry. Sociodemographic variables, clinical variables, comorbidities, activity and damage scores were described. CVD was defined as at least one of the following: peripheral arterial disease, ischemic heart disease, or cerebrovascular accident. All patients with at least one CVD were included in our analysis (heart attack, central nervous system vascular disease, and peripheral arteries atherosclerotic disease). The event classified for the analysis was that after the diagnosis of SLE. SLE diagnosis was previous to CVD. Two groups matched by age and sex, 1:2 were formed. Results: a total of 1515 patients older than 18 years participated in the registry. Eighty patients with CVD (5.3%) were described in the registry. Two-hundred and forty patients were included, according to two groups. The mean age was 47.8 (SD 14.4) and 47.6 (SD 14.2) in patients with and without CVD, respectively. Patients with CVD had a longer duration of SLE in months, a higher Charlson index, a higher SLICC, increased frequency of neurological manifestations, antiphospholipid syndrome, hospitalizations, and use of cyclophosphamide. The associated variables in the multivariate were the Charlson Index (p=0.004) and the SLICC (p<0.001). Conclusions: CVDs have a significant influence on our patients, being associated with a greater possibility of damage and comorbidities.References
I. Urowitz MB, Gladman D, Ibanez D, Fortin P, SanchezGuerrero J, Bae S, et al. Accumulation of coronary artery disease risk factors over three years: data from an international inception cohort. Arthritis Rheum 2008 Feb 15;59(2):176-80. doi:0.1002/art.23353.
II. Urowitz MB, Gladman DD, Abu-Shakra M, Farewell VT. Mortality studies in systemic lupus erythematosus. Results from a single center. III. Improved survival over 24 years. J Rheumatol 1997 Jun;24(6):1061-5.
III. Bruce IN. ‘Not only...but also’: factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology (Oxford) 2005 Dec;44(12):1492-502. doi: 10.1093/rheumatology/kei142.
IV. Malik M, Gor R, Siddiqui NA, Gor D, Ahmed KI. Elucidating the intriguing association between systemic lupus erythematosus and cardiovascular disease. Cureus 2021 Jun 9;13(6):e15538. doi: 10.7759/cureus.15538.
V. El-Magadmi M, Bodill H, Ahmad Y, Durrington PN, Mackness M, Walker M, et al. Systemic lupus erythematosus: an independent risk factor for endothelial dysfunction in women. Circulation 2004 Jul 27;110(4):399-404. doi: 10.1161/01.CIR.0000136807.78534.50.
VI. Bessant R, Duncan R, Ambler G, Swanton J, Isenberg DA, Gordon C, Rahman A. Prevalence of conventional and lupus-specific risk factors for cardiovascular disease in patients with systemic lupus erythematosus: A casecontrol study. Arthritis Rheum 2006 Dec 15;55(6):892-9. doi: 10.1002/art.22343.
VII. Aviña-Zubieta JA, To F, Vostretsova K, De Vera M, Sayre EC, Esdaile JM. Risk of myocardial infarction and stroke in newly diagnosed systemic lupus erythematosus: a general population-based study. Arthritis Care Res (Hoboken) 2017 Jun;69(6):849-856. doi: 10.1002/acr.23018.
VIII. Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001 Oct;44(10):2331-7. doi: 10.1002/1529-0131(200110)44:10<2331::aid-art395>3.0.co;2-i.
IX. Bertoli AM, Vilá LM, Alarcón GS, McGwin G, Edberg JC, Petri M, et al. PROFILE Study Group. Factors associated with arterial vascular events in PROFILE: a multiethnic lupus cohort. Lupus 2009 Oct;18(11):958-65. doi: 10.1177/0961203309104862.
X. Fernández-Nebro A, Rúa-Figueroa Í, López-Longo FJ, Galindo-Izquierdo M, Calvo-Alén J, Olivé-Marqués A, et al. Cardiovascular events in systemic lupus erythematosus. A Nationwide Study in Spain From the RELESSER Registry. Medicine (Baltimore) 2015 Jul;94(29):e1183. doi: 10.1097/MD.0000000000001183.
XI. García MA, Alba P, Del Campo-Pérez V, Roverano S, Quintana RM, Álvarez AP, et al. Multicenter lupus register from Argentina, the RELESSAR database: influence of ethnicity on disease phenotype. Lupus 2022 Apr;31(5):637-645. doi: 10.1177/09612033221083267.
XII. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997 Sep;40(9):1725. doi: 10.1002/art.1780400928.
XIII. Gladman D, Urowitz M, Fortin P, Isenberg D, Goldsmith C, Gordon C, et al. Systemic Lupus International Collaborating Clinics conference on assessment of lupus flare and quality of life measures in SLE. Systemic Lupus International Collaborating Clinics Group. J Rheumatol 1996 Nov;23(11):1953-5.
XIV. Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA Jr, Jansen-McWilliams L, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997 Mar 1;145(5):40815. doi: 10.1093/oxfordjournals.aje.a009122.
XV. Toloza SM, Uribe AG, McGwin G Jr, Alarcón GS, Fessler BJ, Bastian HM, et al; LUMINA Study Group. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. Arthritis Rheum 2004 Dec;50(12):3947-57. doi: 10.1002/ art.20622.
XVI. Becker-Merok A, Nossent J. Prevalence, predictors and outcome of vascular damage in systemic lupus erythematosus. Lupus 2009 May;18(6):508-15. doi: 10.1177/0961203308099233.
XVII. Mikdashi J, Handwerger B, Langenberg P, Miller M, Kittner S. Baseline disease activity, hyperlipidemia, and hypertension are predictive factors for ischemic stroke and stroke severity in systemic lupus erythematosus. Stroke 2007; 38:281-285. https://doi.org/10.1161/01. STR.0000254476.05620.14
XVIII. Urowitz MB, Ibañez D, Gladman DD. Atherosclerotic vascular events in a single large lupus cohort: prevalence and risk factors. J Rheumatol 2007 Jan;34(1):70-5.
XIX. Gustafsson J, Gunnarsson I, Börjesson O, Pettersson S, Möller S, Fei GZ, et al. Predictors of the first cardiovascular event in patients with systemic lupus erythematosus - a prospective cohort study. Arthritis Res Ther 2009;11(6):R186. doi: 10.1186/ar2878.
XX. Tesfamicael R, Lam H, Lu O, Kapadia R, Siegel C, Sahakian L, et al. Lupus low disease activity state: predicting organ damage accrual and cardiovascular risk in patients with systemic lupus erythematosus [abstract]. Arthritis Rheumatol 2018; 70 (suppl 9)
XXI. Bruce IN. Coronary heart disease (CHD) in lupus: round up the usual suspects? Lupus 2004;13(8):557-60. doi: 10.1191/0961203304lu1066ed.
XXII. Thiagarajan P. Atherosclerosis, autoimmunity, and systemic lupus erythematosus. Circulation 2001 Oct 16;104(16):1876-7.
XXIII. Gustafsson JT, Herlitz Lindberg M, Gunnarsson I, Pettersson S, Elvin K, Öhrvik J, et al. Excess atherosclerosis in systemic lupus erythematosus. A matter of renal involvement: case control study of 281 SLE patients and 281 individually matched population controls. PLoS One 2017 Apr 17;12(4):e0174572. doi: 10.1371/journal. pone.0174572.
XXIV. Bengtsson C, Ohman ML, Nived O, Rantapää-Dahlqvist S. Cardiovascular event in systemic lupus erythematosus in northern Sweden: incidence and predictors in a 7-year follow-up study. Lupus 2012 Apr;21(4):452-9. doi: 10.1177/0961203311425524. Epub 2011 Nov 7.
XXV. Ruiz-Irastorza G, Egurbide MV, Pijoan JI, Garmendia M, Villar I, Martínez-Berriotxoa A, et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus 2006;15(9):577-83. doi: 10.1177/0961203306071872.
XXVI. Kaiser R, Cleveland CM, Criswell LA. Risk and protective factors for thrombosis in systemic lupus erythematosus: results from a large, multi-ethnic cohort. Ann Rheum Dis 2009 Feb;68(2):238-41. doi: 10.1136/ ard.2008.093013.
XXVII. Jung H, Bobba R, Su J, Shariati-Sarabi Z, Gladman DD, Urowitz M, et al. The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus. Arthritis Rheum 2010 Mar;62(3):863-8. doi: 10.1002/art.27289.
XXVIII. Penn SK, Kao AH, Schott LL, Elliott JR, Toledo FG, Kuller L, et al. Hydroxychloroquine and glycemia in women with rheumatoid arthritis and systemic lupus erythematosus. J Rheumatol 2010 Jun;37(6):1136-42. doi: 10.3899/jrheum.090994.
Copyright (c) 2023 on behalf of the authors. Reproduction rights: Argentine Society of Rheumatology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
