Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Abstract

Objective. To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds.Methods. SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins.Results. We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean ؎ SD age at SLE diagnosis was 35.7 ؎ 14 years. After a followup of 3,094 patientyears, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P ‫؍‬ 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events.Conclusion. There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.Premature atherosclerosis is a major cause of mortality and late morbidity in patients with systemic lupus erythematosus (SLE) (1-3). In several cohort studies, it was found that atherosclerotic cardiovascular and cerebrovascular diseases are more common causes of late deaths than active SLE itself (1,(4)(5)(6). More recent studies have demonstrated that subclinical coronary heart disease and carotid plaque were present in a significantly higher proportion of SLE patients than in age-and sex-matched control subjects with similar risk factors (7,8). The etiology of accelerated atherosclerosis in SLE is multifactorial and cannot be fully explained by traditional risk factors (9).Compared with individuals without SLE, the risk of myocardial infarction in SLE patients is 2-50 times higher, and the risk of stroke is 2-10 times higher (2,9,10). The prevalence of symptomatic coronary heart disease in SLE patients has been reported to be 6-20%, The Hopkins Lupus Cohort is supported by NIH grants R01-AR-43727 and M01-RR-00052 (to the outpatient Clinical Research Center).

Whole blood viscosity and arterial thrombotic events in patients with systemic lupus erythematosus

“…The estimated 5-year risk of arterial thrombosis ranges from 5.1% to 8.5%, while 5-year venous thrombosis risk ranges from 3.7% to 10.3% (1). Consequently, patients with SLE have a significantly increased risk of premature cerebrovascular accident (CVA) and myocardial infarction (MI) compared with agematched controls (2)(3)(4)(5).…”

The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus

“…Thrombosis Independent of aPL, because of the increased incidence of traditional cardiovascular disease (CVD) and non-traditional lupus-related risk factors, e.g., inflammation, renal disease, or corticosteroids, SLE patients are at significantly increased risk of premature atherosclerosis and/or thrombosis (24,25). In general, the prevalence of vascular events in SLE patients is 10%-30% (26), symptomatic coronary artery disease (CAD) 6%-20% (27)(28)(29), stroke 2%-15% (28)(29)(30), and subclinical CAD 30%-40% (27,31). A Patient Discharge Database analysis has estimated that women with SLE, aged 18-44 years, are hospitalized with myocardial infarction or stroke almost twice more often than the general population (28).…”

Recent‐onset systemic lupus erythematosus complicated by acute respiratory failure

“…Although she had no history of prior thrombosis or miscarriage, antiphospholipid antibodies are present in approximately 28 -40% of SLE patients and carry an increased risk for arterial and venous thrombosis (4,5). While Ͻ40% of SLE patients with antiphospholipid antibodies develop thrombosis (2), pulmonary embolus should be considered in SLE patients with hypoxia.…”