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Published on: August 28, 2018
Coronary calcification in SLE: comparison with the Multi-Ethnic Study of Atherosclerosis
Adnan N Kiani1, Laurence S Magder2, Wendy S Post1
1Department of Medicine, Division of Rheumatology, Johns Hopkins University.
Insights
Female patients with Systemic Lupus Erythematosus (SLE) have a significantly higher prevalence of coronary artery calcium (CAC) compared to women without SLE, particularly in the 45-54 age group. This increased cardiovascular risk is evident even after accounting for traditional risk factors.
Area of Science:
- Cardiovascular Disease Research
- Rheumatology
- Epidemiology
Background:
- Accelerated atherosclerosis is a primary cause of mortality in Systemic Lupus Erythematosus (SLE).
- Understanding cardiovascular disease (CVD) risk in SLE patients is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the prevalence and extent of coronary artery calcium (CAC) in female SLE patients versus a non-SLE control group.
- To investigate if SLE is an independent risk factor for subclinical atherosclerosis.
Main Methods:
- Coronary artery calcium (CAC) was measured in 80 female SLE patients and 241 female controls (aged 45-64) from the Multi-Ethnic Study of Atherosclerosis (MESA).
- Statistical analyses included binary regression for prevalence and linear models for CAC quantity, controlling for demographic and cardiovascular risk factors.
Main Results:
- CAC prevalence was substantially higher in SLE patients (58% vs. 20% in ages 45-54, P < 0.0001).
- This difference persisted after adjusting for traditional CVD risk factors.
- The quantity of CAC (Agatston score) did not significantly differ between groups among those with CAC.
Conclusions:
- Women with SLE exhibit a higher prevalence of CAC compared to non-SLE women.
- This increased prevalence is particularly notable in younger SLE patients (45-54 years).
- SLE is associated with increased subclinical coronary atherosclerosis, independent of conventional risk factors.
Objective:
Accelerated atherosclerosis is a major cause of morbidity and death in SLE. The purpose of this study was to determine whether the prevalence and extent of coronary artery calcium (CAC) is higher in female SLE patients compared with a non-SLE sample from the Multi-Ethnic Study of Atherosclerosis (MESA).
Methods:
CAC was measured in 80 female SLE patients and 241 female MESA controls from the Baltimore Field Centre, ages 45-64 years, without evidence of clinical cardiovascular disease. Binary regression was used to estimate the ratio of CAC prevalence in SLE vs MESA controls, controlling for demographic and cardiovascular risk factors. To compare the groups with respect to the quantity of CAC among those with non-zero Agatston scores, we used linear models in which the outcome was a log-transformed Agatston score.
Results:
The prevalence of CAC was substantially higher in SLE. The differences were most pronounced and statistically significant in those aged 45-54 years (58% vs 20%, P < 0.0001), but were still observed among those aged 55-65 years (57% vs 36%, P = 0.069). After controlling for age, ethnicity, education, income, diabetes mellitus, hypertension, hyperlipidaemia, high-density lipoprotein levels, smoking, education and BMI, SLE patients still had a significantly higher prevalence of CAC than controls. Among those with CAC, the mean log Agatston score did not differ significantly between SLE and MESA participants.
Conclusion:
Women with SLE have a higher prevalence of CAC than comparable women without SLE, even after adjusting for traditional cardiovascular risk factors, especially among those aged 45-54 years.
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