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Assessment of coronary risk based on cumulative exposure to lipids in systemic lupus erythematosus

Mandana Nikpour1, Dafna D Gladman, Dominique Ibanez

  • 1From the University of Toronto Lupus Clinic and the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada; The University of Melbourne Departments of Medicine and Rheumatology, St. Vincent's Hospital, Melbourne, Victoria, Australia; Division of Cardiology, Women's College Hospital, Toronto, Ontario, Canada.

The Journal of Rheumatology
|October 17, 2013
PubMed

Insights

Systemic lupus erythematosus (SLE) patients show increased coronary risk linked to low-density lipoprotein cholesterol (LDL-C), total cholesterol to HDL cholesterol ratio (TC:HDL-C), and triglycerides (TG). These lipid markers help assess cardiovascular risk in SLE.

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Clinical Chemistry

Background:

  • Systemic lupus erythematosus (SLE) is associated with an elevated risk of coronary events.
  • Lipid profiles are crucial in cardiovascular risk assessment, but their specific role in SLE requires further quantification.

Purpose of the Study:

  • To determine the independent contribution of low-density lipoprotein cholesterol (LDL-C), total cholesterol to high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) levels, and HDL-C to coronary risk in patients with SLE.

Main Methods:

  • Utilized data from patients with lipid measurements prior to a coronary event or last clinic visit.
  • Employed time-adjusted mean (TAM) calculations for lipid variables.
  • Applied time-dependent proportional hazards regression models to assess coronary event risk (myocardial infarction or angina), adjusting for age.

Main Results:

  • Among 384 SLE patients followed for a mean of 3.81 years, 21 coronary events occurred.
  • Mean and TAM LDL-C (HR 1.83), TC:HDL-C ratio (HR 1.43), and TG (HR 2.11) were significant predictors of coronary events.
  • A TAM LDL-C cutpoint of 2.0 mmol/l demonstrated high sensitivity (85.7%) and negative predictive value (93.9%) for coronary events, though specificity was low (12.7%).

Conclusions:

  • LDL-C, TC:HDL-C ratio, and TG are independently associated with increased coronary risk in SLE patients.
  • The magnitude of this risk has been quantified, aiding in risk stratification.
  • SLE-specific lipid risk assessment levels can be developed to optimize predictive values for coronary events.
Abstract

Keywords:
CORONARY ARTERY DISEASELIPIDSLIPOPROTEINSRISK FACTORSSYSTEMIC LUPUS ERYTHEMATOSUS

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