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Vascular events in hypertensive patients with systemic lupus erythematosus
P Rahman1, S Aguero, D D Gladman
1Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
Insights
Systemic hypertension significantly increases vascular event risk in Systemic Lupus Erythematosus (SLE) patients. Hypercholesterolemia emerged as the strongest predictor, highlighting its crucial role in SLE vascular complications.
Area of Science:
- Rheumatology
- Cardiology
- Internal Medicine
Background:
- Systemic Lupus Erythematosus (SLE) is an autoimmune disease associated with increased cardiovascular risk.
- Hypertension is a common comorbidity in SLE patients, but its specific impact on vascular events requires further investigation.
Purpose of the Study:
- To prospectively examine the relationship between systemic hypertension and the occurrence of vascular events in patients diagnosed with SLE.
- To identify risk factors associated with vascular disease development in hypertensive versus normotensive SLE patients.
Main Methods:
- A prospective cohort study identified 150 SLE patients within one year of diagnosis (1980-1988).
- Standardized definitions were used for hypertension and vascular events (myocardial infarction, angina, cerebrovascular accident, peripheral vascular disease).
- Multivariate logistic regression analyzed predictors of vascular events, comparing hypertensive and normotensive groups.
Main Results:
- Hypertensive SLE patients (n=75) experienced significantly more vascular events (22.7%) compared to normotensive patients (n=75, 8.0%; p=0.022).
- Vascular events included coronary artery disease, cerebrovascular accidents, and peripheral vascular disease.
- Hypercholesterolemia (OR 6.9), azotemia, and corticosteroid use were more frequent in the hypertensive group. Hypercholesterolemia was the strongest predictor of vascular events (P < 0.001).
Conclusions:
- Systemic hypertension is independently associated with an increased frequency of vascular events in SLE patients.
- Hypercholesterolemia appears to be a key mediator explaining the link between hypertension and vascular events in this population.
- Managing hypertension and hypercholesterolemia is crucial for reducing vascular risk in SLE.
Abstract:
Our purpose was to examine prospectively the relationship between systemic hypertension and vascular events in patients with SLE. SLE patients followed in the University of Toronto Lupus Clinic presenting between 1980 and 1988 and within one year of their diagnosis of SLE were identified. Standard definitions were used for hypertension and for all vascular events (MI, angina, CVA, PVD). The presence of traditional CAD risk factors, along with disease- and therapy-related risk factors for the development of vascular disease, were compared in the hypertensive and normotensive group. A multivariate logistic regression was performed to determine the best predictor of a vascular event. One hundred and fifty patients were identified in our inception cohort [75 hypertensive (50%) and 75 (50%) normotensive]. Seventeen hypertensive patients (22.7%) had at least one vascular event as compared to six (8.0%) normotensive patients (p = 0.022). The vascular events included 7 with CAD, 5 with CVA, and 5 with PVD in the hypertensive group while in the normotensive group 3 patients developed CAD, 2 CVA and 1 PVD. Fifteen deaths were recorded in the hypertensive group as compared to eight deaths in the non-hypertensive groups (P = 0.09). The groups were comparable with respect to associated risk factors, except for higher frequency of hypercholesterolemia (P = 0.003), azotemia (P = 0.001) and corticosteroid use (P = 0.038) in the hypertension group. In a multivariate analysis the best predictor of a vascular event was hypercholesterolemia (OR 6.9, 95% CI 2.4-24.8, P < 0.001). We conclude that systemic hypertension is associated with an increased frequency of vascular events in SLE. This is best explained by its association with hypercholesterolemia.