Background Objective: To determine the risk factors associated with the development of cardiovascular events (CVE) in a multi-ethnic Asian cohort of Singapore Systemic Lupus Erythematosus (SLE) patients

Methods We analysed patients in a prospective SLE cohort Tock Seng Hospital (TTSH) in Singapore during the period 2002 to 2017. Patients without prior CVE at baseline visit (V0) who subsequently developed CVE during the follow-up were identified from this registry. Clinical information on traditional, SLE-associated, and treatment-associated risk factors were collected at baseline and at follow up. Predictors associated with development of CVE were analyzed using Chi-squared test and student’s t test.

Results Out of 1000 patients recruited, 132 were excluded due to prior CVE before V0 and/or withdrew consent. Of the remaining 868 patients, 42 (4.8%) developed a CVE (16 angina/acute myocardial infarction/ischaemic heart disease, 17 cerebrovascular accidents, 11 arterial thrombosis/peripheral vascular disease) after a median (Interquartile range IQR) time of 6.18 (2.70 – 9.13) years. Of those who developed CVE, the median (IQR) age of SLE diagnosis was 34.75 (25.89 – 44.95) years and median (IQR) SLE duration was 10.66 (4.31 – 15.45) years before CVE onset. The risk factors for development of CVE (p<0.05) include onset of SLE at an older age, longer disease duration, longer exposure to corticosteroids, less usage of hydroxychloroquine, presence of hypertension, hyperlipidemia, antiphospholipid syndrome and lower creatinine clearance at time of enrolment into the study.

Conclusions Besides traditional risk factors, age, disease duration and corticosteroid use are predictors of CVE in this prospective study. The use of hydroxychloroquine appear to be protective.