Predictors of the first cardiovascular event in patients with systemic lupus erythematosus - a prospective cohort study

Abstract

IntroductionCardiovascular disease (CVD) is a major cause of premature mortality among Systemic lupus erythematosus (SLE) patients. Many studies have measured and evaluated risk factors for premature subclinical atherosclerosis, but few studies are prospective and few have evaluated risk factors for hard endpoints, i.e. clinically important cardiovascular events (CVE). We investigated the impact of traditional and lupus associated risk factors for the first ever CVE in a longitudinal cohort of SLE patients.MethodsA total of 182 SLE patients (mean age 43.9 years) selected to be free of CVE were included. Cardiovascular and autoimmune biomarkers were measured on samples collected after overnight fasting at baseline. Clinical information was collected at baseline and at follow up. End point was the first ever CVE (ischemic heart, cerebrovascular or peripheral vascular disease or death due to CVD). Impact of baseline characteristics/biomarkers on the risk of having a first CVE was evaluated with Cox regression.ResultsFollow up was 99.5% after a mean time of 8.3 years. Twenty-four patients (13%) had a first CVE. In age-adjusted Cox regression, any positive antiphospholipid antibody (aPL), elevated markers of endothelial activation (von Willebrand factor (vWf), soluble vascular cellular adhesion molecule-1 (sVCAM-1)) and fibrinogen predicted CVEs. Of SLE manifestations, arthritis, pleuritis and previous venous occlusion were positively associated with future CVEs while thrombocytopenia was negatively associated. Among traditional risk factors only age and smoking were significant predictors. In a multivariable Cox regression model age, any positive aPL, vWf and absence of thrombocytopenia were all predictors of the first CVE.ConclusionsIn addition to age, positive aPL, biomarkers indicating increased endothelial cell activity/damage, and absence of thrombocytopenia were independent predictors of CVEs in this prospective study. Our results indicate that activation of the endothelium and the coagulation system are important features in SLE related CVD. Furthermore, we observed that the risk of CVEs seems to differ between subgroups of SLE patients.

Physical Activity Program Is Helpful for Improving Quality of Life in Patients with Systemic Lupus Erythematosus

“…Although physical activity can prevent long-term consequences of SLE such as obesity, osteoporosis and premature cardiovascular and cerebrovascular diseases risk (Petri et al 1992;Svenungsson et al 2001;Bruce et al 2003;Oeser et al 2005;Goldberg et al 2009;Gustafsson et al 2009;Urowitz et al 2008;Volkmann et al 2010), in John Hopkins Lupus Cohort, 70% of patients reported a sedentary lifestyle (Petri et al 1992). Although physical activity reduces the patients' fear of disability, there is still a great difference of opinion about the time of onset, type and intensity of that activity.…”

“…Although physical activity reduces the patients' fear of disability, there is still a great difference of opinion about the time of onset, type and intensity of that activity. Knowing the physiology of physical activity will be reasonable to apply it during treatment or as an early prevention of the disease's sequelae (Krupp et al 1991;Gustafsson et al 2009;Volkmann et al 2010). It is unknown which type and intensity of physical activity contributes most to the treatment.…”

Cardiovascular events in patients with systemic lupus erythematosus and their association with cardiovascular risk factors

“…Los mecanismos subyacentes a una acelerada aterosclerosis en el LES son complejos y son áreas de activa investigación. Aunque los riesgos tradicionales como la dislipidemia y el tabaquismo han sido demostrados como factores predictores de riesgo cardiovascular en pacientes con LES, el lupus en sí mismo es un factor de riesgo independiente para enfermedad cardiovascular [7,14,23]. Varios tipos de enfermedad cardiovascular fueron observados entre los pacientes con LES, incluyendo pericarditis, miocarditis, enfermedad del sistema de conducción, vasculitis, enfermedad valvular, así como también enfermedad coronaria, enfermedad cerebrovascular, insuficiencia cardiaca congestiva y enfermedad arterial periférica [11].…”

“…En el estudio LUMINA [24] la presencia de anticuerpos antifosfolipídicos estuvo significativamente asociada a un incremento del riesgo 4 veces mayor de tener un evento cardiovascular en un promedio de tiempo de aproximadamente 6 años. La presencia de anticuerpos antifosfolipídicos también estuvo asociada a un incremento de 4 veces más el riesgo de presentar un infarto de miocardio, accidente cerebrovascular en un estudio de 182 mujeres con diagnóstico de LES seguidas en promedio por 8,3 años [23,27]. Si bien en nuestro estudio se analizó la presencia del diagnóstico de SAF y se encontró una asociación significativa con los accidentes cerebrovasculares, no se realizó un estudio centrado en la positividad o en los títulos de los anticuerpos antifosfolipídicos de forma específica, pero la asociación encontrada sugiere esta relación coincidiendo con la literatura.…”

Determinants of premature mortality in a city population: An eight-year observational study concerning subjects aged 18–64

“…Attempts to find risk factors for premature death, that is identification of the aspects of lifestyle which contribute to death, are closely connected with Dahlgren and Whitehead's modern model of health [2]. There are numerous population studies presenting the problem [3][4][5][6][7][8][9][10]. Long-term studies on changes in mortality in the second half of the 20th century confirm that the state of health in all age groups, also in the productive age, has deteriorated with regard to non-communicable diseases, especially cardiovascular diseases, in Poland until 1991.…”