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Risk factors for coronary artery disease in patients with systemic lupus erythematosus
M Petri1, S Perez-Gutthann, D Spence
1Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
Patients with systemic lupus erythematosus (SLE) have a higher risk of coronary artery disease (CAD). Key risk factors include older age, longer disease duration, and elevated cholesterol, hypertension, and obesity. Management should focus on preventing these CAD risk factors.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
- Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in SLE patients.
- Understanding CAD risk factors in SLE is crucial for effective management.
Purpose of the Study:
- To determine the incidence of coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE).
- To identify risk factors associated with the development of CAD in this patient population.
Main Methods:
- Prospective longitudinal study of 229 SLE patients from The Johns Hopkins Lupus Cohort.
- CAD defined by angina, myocardial infarction, or sudden death.
- Risk factor data collected every 3 months; analyzed using logistic regression.
Main Results:
- CAD occurred in 8.3% of SLE patients.
- CAD was associated with older age at SLE diagnosis and cohort entry, longer SLE duration, and prolonged prednisone use.
- Hypertension, elevated cholesterol (>200 mg/dL), and obesity were significant risk factors for CAD.
Conclusions:
- Patients with SLE exhibit a notable frequency of CAD.
- Primary and secondary prevention strategies targeting hypertension, hypercholesterolemia, and obesity are essential in managing SLE patients.
- Routine screening and management of these risk factors can mitigate cardiovascular events in SLE.
Purpose:
To estimate the frequency of and examine risk factors for coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE) in a prospective longitudinal study.
Patients And Methods:
Patients were SLE are enrolled in The Johns Hopkins Lupus Cohort, a prospective study of outcomes in 229 subjects with SLE. CAD was defined as angina, myocardial infarction, or sudden death. Data on CAD risk factors were obtained prospectively every 3 months and were analyzed using univariate and multiple logistic regression.
Results:
CAD occurred in 19 (8.3%) of 229 patients with SLE and accounted for 3 (30%) of 10 deaths as of December 31, 1990. Compared to subjects without CAD, those with CAD were more likely to have been older at both diagnosis of SLE (37.1 years versus 28.9 years, p = 0.004) and at entry into the cohort (47.1 years versus 34.7 years, p < 0.0001), to have a longer mean duration of SLE (12.3 years versus 8.1 years, p = 0.013) and a longer mean duration of prednisone use (14.3 years versus 7.2 years, p < 0.0001), to have a higher mean serum cholesterol (271.2 mg/dL versus 214.9 mg/dL, p < 0.0001) or a cholesterol level greater than 200 mg/dL (odds ratio [OR] 14.5, 95% confidence intervals [CI] 1.9, 112.1), and to have both a history of hypertension (OR 3.5, 95% CI 1.3, 9.6) and a history of use of antihypertensive medications (OR 5.5, 95% CI 1.8, 17.2). There were no significant associations with other known CAD risk factors such as smoking, diabetes, family history of CAD, race, or sex, or variables related to steroid therapy including the presence of cushingoid features or ever use of corticosteroids. The best multiple logistic regression model for CAD included age at diagnosis, duration of prednisone use, requirement for antihypertensive treatment, maximum cholesterol level, and obesity (using NHANES-II [National Health and Nutrition Examination Survey] definitions).
Conclusion:
Primary and secondary prevention strategies directed at hypertension, hypercholesterolemia, and obesity, as well as other known CAD risk factors, should be routinely employed in the management of patients with SLE.