Cardiovascular Events in Systemic Lupus Erythematosus

Abstract

This article estimates the frequency of cardiovascular (CV) events that occurred after diagnosis in a large Spanish cohort of patients with systemic lupus erythematosus (SLE) and investigates the main risk factors for atherosclerosis.RELESSER is a nationwide multicenter, hospital-based registry of SLE patients. This is a cross-sectional study. Demographic and clinical variables, the presence of traditional risk factors, and CV events were collected. A CV event was defined as a myocardial infarction, angina, stroke, and/or peripheral artery disease. Multiple logistic regression analysis was performed to investigate the possible risk factors for atherosclerosis.From 2011 to 2012, 3658 SLE patients were enrolled. Of these, 374 (10.9%) patients suffered at least a CV event. In 269 (7.4%) patients, the CV events occurred after SLE diagnosis (86.2% women, median [interquartile range] age 54.9 years [43.2–66.1], and SLE duration of 212.0 months [120.8–289.0]). Strokes (5.7%) were the most frequent CV event, followed by ischemic heart disease (3.8%) and peripheral artery disease (2.2%). Multivariate analysis identified age (odds ratio [95% confidence interval], 1.03 [1.02–1.04]), hypertension (1.71 [1.20–2.44]), smoking (1.48 [1.06–2.07]), diabetes (2.2 [1.32–3.74]), dyslipidemia (2.18 [1.54–3.09]), neurolupus (2.42 [1.56–3.75]), valvulopathy (2.44 [1.34–4.26]), serositis (1.54 [1.09–2.18]), antiphospholipid antibodies (1.57 [1.13–2.17]), low complement (1.81 [1.12–2.93]), and azathioprine (1.47 [1.04–2.07]) as risk factors for CV events.We have confirmed that SLE patients suffer a high prevalence of premature CV disease. Both traditional and nontraditional risk factors contribute to this higher prevalence. Although it needs to be verified with future studies, our study also shows—for the first time—an association between diabetes and CV events in SLE patients.

Cardiovascular disease in immune-mediated inflammatory diseases

“…[30] In addition, comparing with a Spanish systemic lupus erythematosus registry, [31] we observed a lower prevalence of CVD and a lack of influence of traditional cardiovascular risk factors. However, surrogate markers of disease severity were independent risk factors in both studies.…”

Etiologies des accidents vasculaires cérébraux ischémiques chez les jeunes: apport de l’interniste

“…Les événements cérébro-vasculaires comptent pour 20 à 30% des causes de mortalité chez les patients lupiques, ces mêmes patients avaient 2.04 fois plus de risque d'être hospitalisés pour un AVCI que la population générale [ 7 ]. En plus des facteurs classiques d'athérosclérose, les patients lupiques ont des facteurs de risque particuliers prédisposant aux événements vasculaires, ainsi une large étude espagnole a montré que la présence d'une sérite, d'un complément bas, d'une atteinte neuropsychiatrique du lupus, d'une atteinte valvu-laire ainsi que la présence d'anticorps antiphospholipides augmentaient le risque d'avoir un événement cardiovasculaire, sans avoir trouvé une association avec le score SLEDAI [ 8 ]. Pourtant une relation semble exister entre l'activité du lupus et le risque augmenté d'un événement vasculaire [ 9 , 10 ], dans notre étude la majorité de nos patients étaient en poussée de leur maladie avec un SLEDAI élevé au moment de l'AVCI.…”

The incidence of cardiovascular events in Italian patients with systemic lupus erythematosus is lower than in North European and American cohorts

“…Data from the Italian registry Progetto Cuore [ 21 ] were used to compare the incidence of ischemic coronary and cerebral events observed with those of the Italian general population. Moreover, the detected incidences were compared with those reported in other European (Spanish and Swedish) [ 10 – 12 ] and American (from Maryland, Alabama, and Wisconsin) [ 7 – 9 ] SLE cohorts in which the respective item had been evaluated. In addition, baseline characteristics and traditional risk-factors between patients with and without CV events and among the distinct cohorts were compared.…”

“…[ 10 , 11 ] In that regard, geography and ethnic background might play a role. Actually, the only available study from Mediterranean countries [ 12 ] has pointed out a lower incidence of CV events in Spanish patients with respect to those from North Europe and America.…”