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Co-morbidities
Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort
  1. M B Urowitz1,
  2. D D Gladman1,
  3. N M Anderson1,
  4. J Su1,
  5. J Romero-Diaz2,
  6. S C Bae3,
  7. P R Fortin4,
  8. J Sanchez-Guerrero1,
  9. A Clarke5,
  10. S Bernatsky6,
  11. C Gordon7,
  12. J G Hanly8,
  13. D J Wallace9,
  14. D Isenberg10,
  15. A Rahman10,
  16. J Merrill11,
  17. E Ginzler12,
  18. G S Alarcón13,
  19. B F Fessler13,
  20. M Petri14,
  21. I N Bruce15,16,
  22. M Khamashta17,
  23. C Aranow18,
  24. M Dooley19,
  25. S Manzi20,
  26. R Ramsey-Goldman21,
  27. G Sturfelt22,
  28. O Nived22,
  29. K Steinsson23,
  30. A Zoma24,
  31. G Ruiz-Irastorza25,
  32. S Lim26,
  33. K C Kalunian27,
  34. M Ỉnanç28,
  35. R van Vollenhoven29,
  36. M Ramos-Casals30,
  37. D L Kamen31,
  38. S Jacobsen32,
  39. C Peschken33,
  40. A Askanase34 and
  41. T Stoll35
  1. 1Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto Ontario, Canada
  2. 2Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico
  3. 3Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  4. 4Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada
  5. 5Division of Rheumatology, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
  6. 6Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
  7. 7Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  8. 8Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
  9. 9Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  10. 10Centre for Rheumatology Research, University College, London, UK
  11. 11Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
  12. 12Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
  13. 13Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  14. 14Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  15. 15Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
  16. 16NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, London, UK
  17. 17Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King's College London School of Medicine, London, UK
  18. 18Feinstein Institute for Medical Research, Manhasset, New York, USA
  19. 19Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  20. 20Department of Medicine, West Penn Allegheny, Pittsburgh, Pennsylvania, USA
  21. 21Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA
  22. 22Department of Rheumatology, University Hospital Lund, Lund, Sweden
  23. 23Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland
  24. 24Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
  25. 25Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces., University of the Basque Country, Barakaldo, Spain
  26. 26Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
  27. 27UCSD School of Medicine, La Jolla, California, USA
  28. 28Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
  29. 29Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute, Stockholm, Sweden
  30. 30Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
  31. 31Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
  32. 32Department of Rheumatology Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  33. 33Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  34. 34Division of Rheumatology, Columbia University Medical Center, New York, USA
  35. 35Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland
  1. Correspondence to Dr Murray B Urowitz; m.urowitz{at}utoronto.ca

Abstract

Objective To describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up.

Methods The systemic lupus international collaborating clinics (SLICC) atherosclerosis inception cohort enters patients within 15 months of SLE diagnosis. MIs were reported and attributed on a specialised vascular event form. MIs were confirmed by one or more of the following: abnormal ECG, typical or atypical symptoms with ECG abnormalities and elevated enzymes (≥2 times upper limit of normal), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used.

Results 31 of 1848 patients who entered the cohort had an MI. Of those, 23 patients had an MI prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied, 60.9% were female, 78.3% were Caucasian, 8.7% black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5±15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1±7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up. Risk factors associated with early MI in univariate analysis are male sex, Caucasian, older age at diagnosis, hypertension, hypercholesterolaemia, family history of MI and smoking. In multivariate analysis only age (OR=1.06 95% CI 1.03 to 1.09), hypertension (OR=5.01, 95% CI 1.38 to 18.23), hypercholesterolaemia (OR=4.43, 95% CI 1.51 to 12.99) and smoking (OR=7.50, 95% CI 2.38 to 23.57) remained significant risk factors.

Conclusions In some patients with lupus, MI may develop even before the diagnosis of SLE or shortly thereafter, suggesting that there may be a link between autoimmune inflammation and atherosclerosis.

  • Systemic Lupus Erythematosus
  • Cardiovascular Disease
  • Inflammation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/lupus-2015-000143

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