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CE-10 Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort
  1. Murray Urowitz1,
  2. Dafna Gladman1,
  3. Nicole Anderson1,
  4. Jiandong Su1,
  5. Juanita Romero-Diaz2,
  6. Sang Choel Bae3,
  7. Paul Fortin4,
  8. Jorge Sanchez-Guerrero1,
  9. Anne Clarke5,
  10. Sasha Bernatsky6,
  11. Caroline Gordon7,
  12. John Hanly8,
  13. Daniel Wallace9,
  14. David Isenberg10,
  15. Anisur Rahman10,
  16. Joan Merrill11,
  17. Ellen Ginzler12,
  18. Graciela Alarcón13,
  19. Barri Fessler13,
  20. Michelle Petri14,
  21. Ian Bruce15,
  22. Munther Khamashta16,
  23. Cynthia Aranow17,
  24. Mary Anne Dooley18,
  25. Susan Manzi19,
  26. Rosalind Ramsey-Goldman20,
  27. Gunner Sturfelt21,
  28. Ola Nived21,
  29. Kristjan Steinsson22,
  30. Asad Zoma23,
  31. G Ruiz-Irastorza24,
  32. Sam Lim25,
  33. KC Ken Kalunian26,
  34. Murat Inanç27,
  35. Ronald van Vollenhoven28,
  36. Manuel Ramos-Casals29,
  37. Diane Kamen30,
  38. Soren Jacobsen31,
  39. Christine Peschken32,
  40. Anca Askanase33 and
  41. Thomas Stoll34
  1. 1Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, 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, Canada
  6. 6Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, MGill 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, CA, USA
  10. 10Centre for Rheumatology Research, University College, London, UK
  11. 11Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
  12. 12Department of Medicine, SUNY Downstate Medical Centre, Brooklyn, NY, USA
  13. 13Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
  14. 14Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  15. 15Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of
  16. 16Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
  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, NY, USA
  19. 19Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
  20. 20Department of Medicine, West Penn Allegheny, Pittsburgh, PA, USA
  21. 21Northwestern University and Feinberg School of Medicine, Chicago, IL, USA
  22. 22Department of Rheumatology, University Hospital Lund, Lund, Sweden
  23. 23Department of Rheumatology and Centrefor Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland
  24. 24Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland UK; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces., University of the Basque Country, Barakaldo, Spain
  25. 25Emory University, Atlanta, Georgia, USA
  26. 26UCSD School of Medicine, La Jolla, CA, USA
  27. 27Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
  28. 28Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute, Stockholm, Sweden
  29. 29Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
  30. 30Medical University of South Carolina, Charleston, South Carolina, USA
  31. 31Department of Rheumatology Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  32. 32University of Manitoba, Winnipeg, Manitoba, Canada
  33. 33Columbia University Medical Centre, New York, USA
  34. 34Dept. of Rheumatology, Kantousspital, Schaffhausen, Switzerland

Abstract

Background The objective of this study was to describe the frequency of myocardial infarction (MI) prior to the diagnosis of SLE and within the first 2 years of follow-up.

Materials and methods The 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 EKG, typical or atypical symptoms with EKG abnormalities and elevated enzymes (≥2 times ULN), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used.

Results 31 of 1848 patients that 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, hypercholesterolemia, family history of MI and smoking. In multivariate analysis only age (OR = 1.06 95% CI: (1.03, 1.09)), hypertension (OR = 5.01, 95% CI: (1.38, 18.23)), hypercholesterolemia (OR = 4.43, 95% CI: (1.51, 12.99)) and smoking (OR = 7.50, 95% CI: (2.38, 23.57)) remained significant risk factors.

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

Acknowledgements This abstract is being submitted on behalf of the Systemic Lupus International Collaborating Clinics (SLICC) group.

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