The relationship between race, cigarette smoking and carotid intimal medial thickness in systemic lupus erythematosus

Abstract

Objective Racial differences are known to account for a higher incidence of systemic lupus erythematosus (SLE), as well as increased disease severity and mortality. The purpose of this study was to determine if there are any race-specific risk factors that affect measures of subclinical atherosclerosis in SLE patients. Methods Traditional and SLE-related cardiovascular disease (CVD) risk factors were assessed in 106 female SLE patients. Carotid medial intimal medial thickness (mIMT) and coronary artery calcification (CAC) were measured on all subjects. Differences were evaluated between races for all clinical, serologic, and CVD risk factors and the racial interactions with all covariables. Outcomes included mIMT and CAC. Results There were no significant differences between races with regard to mIMT or CAC. Significant covariables in the final model for mIMT included age, triglycerides, glucose, and race-age and race-smoking interactions. A prediction model with fixed significant covariables demonstrated that Black subjects with a smoking history had a significantly higher mIMT than Blacks who had never smoked, an effect not seen in Whites. There were no differences between having CAC or with the CAC scores between the races. In the final model for CAC, age and SLE disease duration were significant covariables impacting CAC. Conclusion When controlling for other significant CVD covariables and interactions, Black women, but not White, with SLE with a history of smoking have higher mIMT measurements than those who have never smoked. This is the first report documenting the race-specific effect of smoking on subclinical measures of CVD in SLE.

Smoking and Its Association With Morbidity in Systemic Lupus Erythematosus Evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index: Preliminary Data and Systematic Review

“…To emphasize the need for more data regarding the cumulative chronic effects of smoking in SLE, we performed a small systematic review. We found more than 222,000 papers about smoking, but only 6 were directly related to smoking exposure and chronic damage among SLE patients (25)(26)(27)(28)(29)(30). Apart from studies that we may have missed in our short systematic review, it seems that the medical literature does not include much on this subject.…”

“…For example, the study by Ward and Studenski evaluated risk factors for the development of end‐stage renal disease, including smoking, and showed significant results. The relationship between smoking and atherosclerosis in SLE patients was also evaluated in 2 previous studies . Scalzi et al studied the effects of smoking on atherosclerosis in African American and white SLE patients.…”

Atherosclerosis in Systemic Lupus Erythematosus – Epidemiology, Risk Factors, Subclinical Assessment and Future Study

“…In a previous study, Scalzi et al [14] found that, amongst African American SLE patients, smokers had greater mean carotid intimamedia thickness, a marker of sub-clinical vascular disease, than nonsmokers, a finding not observed in the Caucasian group, while lipidlowering medication use was less prevalent in African Americans (0% v 22%, p=0.007) [19]. In contrast, the Hopkins Lupus Cohort Study found that 15% of black and 14% of white patients had carotid plaque, in the absence of previous CVD events [20].…”

Subclinical Atherosclerosis in Systemic Autoimmune Disorders

“…Finally, a race-smoking interaction was also identified, as amongst black women with SLE, those with a history of smoking have higher IMT values than non smokers. This effect did not apply to white patients (Scalzi, Bhatt et al 2009). Smoking did not seem to influence subclinical atherosclerotic disease in patients with pSS (Vaudo, Bocci et al 2005;Gerli, Vaudo et al 2010).…”