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Cardiovascular Events in Systemic Lupus Erythematosus: A Nationwide Study in Spain From the RELESSER Registry
Antonio Fernández-Nebro1, Íñigo Rúa-Figueroa, Francisco J López-Longo
1On behalf of EAS-SER (Systemic Diseases Study Group of the Spanish Society of Rheumatology) From the UGC Reumatología (AFN), Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga; Department of Rheumatology (ÍRF), Dr Negrín General University Hospital, Las Palmas de Gran Canaria, Gran Canaria; Department of Rheumatology (FLL), Gregorio Marañón University Hospital; Department of Rheumatology (MGI), Doce de Octubre University Hospital, Madrid; Department of Rheumatology (JCA), Sierrallana Hospital, Torrelavega; Department of Rheumatology (AOM), Germans Trías i Pujol University Hospital, Badalona; UGC Reumatología (COC), Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga; Research Unit of Spanish Society of Rheumatology (MMM), Madrid; Department of Rheumatology (RB), Marqués de Valdecilla University Hospital, Santander; Department of Rheumatology (RMG), Hospital Complex of Ourense, Ourense; Department of Rheumatology (JIR), POVISA Hospital, Vigo; Department of Rheumatology (JBV), Alicante General University Hospital, Alicante; Department of Rheumatology (ETM), La Princesa University Hospital, Madrid; Department of Rheumatology (EUI), Donosti University Hospital, Guipuzcoa; Department of Rheumatology (LHR), Navarra Hospital, Pamplona; Department of Rheumatology (MFG), Juan Canalejo University Hospital, La Coruña; Department of Rheumatology (JN), Bellvitge University Hospital, Barcelona; Department of Rheumatology (ALB), Ramón y Cajal University Hospital, Madrid; Department of Rheumatology (GSS), Marina Baixa University Hospital, Villajoyosa, Alicante; Department of Rheumatology (JAS), Puerta del Hierro-Majadahonda Hospital, Madrid; and University Hospital Complex (JMPR), Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain.
Abstract:
This article estimates the frequency of cardiovascular (CV) events that occurred after diagnosis in a large Spanish cohort of patients with systemic lupus erythematosus (SLE) and investigates the main risk factors for atherosclerosis. RELESSER is a nationwide multicenter, hospital-based registry of SLE patients. This is a cross-sectional study. Demographic and clinical variables, the presence of traditional risk factors, and CV events were collected. A CV event was defined as a myocardial infarction, angina, stroke, and/or peripheral artery disease. Multiple logistic regression analysis was performed to investigate the possible risk factors for atherosclerosis. From 2011 to 2012, 3658 SLE patients were enrolled. Of these, 374 (10.9%) patients suffered at least a CV event. In 269 (7.4%) patients, the CV events occurred after SLE diagnosis (86.2% women, median [interquartile range] age 54.9 years [43.2-66.1], and SLE duration of 212.0 months [120.8-289.0]). Strokes (5.7%) were the most frequent CV event, followed by ischemic heart disease (3.8%) and peripheral artery disease (2.2%). Multivariate analysis identified age (odds ratio [95% confidence interval], 1.03 [1.02-1.04]), hypertension (1.71 [1.20-2.44]), smoking (1.48 [1.06-2.07]), diabetes (2.2 [1.32-3.74]), dyslipidemia (2.18 [1.54-3.09]), neurolupus (2.42 [1.56-3.75]), valvulopathy (2.44 [1.34-4.26]), serositis (1.54 [1.09-2.18]), antiphospholipid antibodies (1.57 [1.13-2.17]), low complement (1.81 [1.12-2.93]), and azathioprine (1.47 [1.04-2.07]) as risk factors for CV events. We have confirmed that SLE patients suffer a high prevalence of premature CV disease. Both traditional and nontraditional risk factors contribute to this higher prevalence. Although it needs to be verified with future studies, our study also shows-for the first time-an association between diabetes and CV events in SLE patients.
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