Factors Associated with Arterial Vascular Events in PROFILE: A Multiethnic Lupus Cohort

Abstract

Summary The objective of this study was to determine the factors associated with the occurrence of arterial vascular events in a multiethnic systemic lupus erythematosus (SLE) cohort. The PROFILE cohort, comprised of SLE patients (n=1,333) of defined ethnicity from five different U.S. institutions, was studied to determine demographic, clinical and biological variables associated with vascular events. An arterial vascular event (first episode) was either a myocardial infarction, angina pectoris and/or a vascular procedure for myocardial infarction, stroke, claudication and/or evidence of gangrene. Patient characteristics were analyzed by univariable and multivariable Cox proportional hazards regression analyses. One-hundred twenty-three (9.8%) patients had at least one incident arterial event. Age at cohort enrollment (HR= 1.04, 95% CI 1.03-1.06), smoking (HR= 2.20, 95% CI 1.40-3.46), and the CRP2* C alleles (HR= 1.91, 95%CI 1.04-3.49) were associated with a shorter time-to-the occurrence of arterial vascular events. Some clinical manifestations of disease activity were associated with a shorter time-to-occurrence [psychosis (HR= 2.21, 95% CI 1.10-4.44), seizures (HR= 1.85, 95% CI 1.00-3.24) and anemia (HR= 1.83, 95% CI 1.02-3.31)], but others were not [arthritis (HR= 0.32, 95% CI 0.18-0.58)]. In conclusion, older patients, especially in the context of a predisposing environmental factor (smoking) and severe clinical manifestations, are at higher risk of having arterial vascular events. The genetic contribution of the variation at the CRP locus was not obscured by demographic or clinical variables. Awareness of these factors should lead to more effective management strategies of patients at risk for arterial vascular events.

Increased Risk of Ischemic Stroke in Patients with Systemic Lupus Erythematosus: A Nationwide Population-based Study

“…SLE may involve multiple organs, and vascular events including ischemic stroke, however, acute myocardial infarction and peripheral arterial occlusive disease are not uncommon (3)(4)(5)(6)(7)(8). Additionally, there are few studies which have compared the risk of developing future ischemic stroke in SLE with that of the general population among Caucasians (9,(20)(21)(22)(23).…”

“…The clinical presentation of SLE varies widely, with periodic flare-ups of symptoms impacting multiple organ systems and resulting in potentially lifethreatening complications (1)(2)(3). Recently, an association has been noted between premature atherosclerosis and this chronic inflammatory disease (3)(4)(5)(6)(7)(8). Accumulating evidence has shown that atherosclerosis is not just a cholesterol storage disorder in vasculature but a sustained, dynamic and chronic inflammatory process.…”

“…Accumulating evidence has shown that atherosclerosis is not just a cholesterol storage disorder in vasculature but a sustained, dynamic and chronic inflammatory process. However, estimates of cardiovascular risk among SLE patients vary widely, and the longterm morbidity and mortality related to atherosclerotic vascular disease in SLE remain substantial (7).…”

Anemia on Admission Predicts Short- and Long-Term Outcomes in Patients with Acute Ischemic Stroke

“…Low hemoglobin levels are associated with decreased oxygencarrying, inflammatory response, alterations in blood viscosity and impairment of cerebral autoregulation (9,10). Nonetheless, data with regard to the relationship between anemia status upon admission and short-and long-term outcome post-stroke are scarce (11)(12)(13). There are no specific recommendations as to the management of acute stroke patients with anemia other than sickle cell disease (14).…”

Frequency of established cardiovascular disease and its risk factors in Chinese patients with systemic lupus erythematosus

“…Cohort and cross-sectional studies reveal that the incidence of CVD in SLE patients ranges from 6.2% to 13% [3][4][5][6][7][8] depending on the duration of observation. Women with lupus in the 35-to 44-year-old age group were over 50 times more likely to experience a myocardial infarction when compared to age-and sex-matched controls [9].…”