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Abstract
Purpose Systemic Lupus Erythematosus (SLE) is associated with an increased cardiovascular risk. Several traditional and disease-specific risk factors have been shown to correlate with the occurrence of cardiovascular events (CVE) in patients with SLE. However, results of previous studies are heterogeneous. The objective of this study was to evaluate the potential predictors of CVE in a large, multiethnic, monocentric cohort of patients with SLE and a long follow-up duration.
Methods Medical records of patients treated at the Lupus Clinic at University College London Hospital (UCLH) between 1979 and 2022 were reviewed. Data about CVE, traditional cardiovascular risk factors, demographic and disease features, and treatment history were collected. Only patients with complete information available were included in the study. Firstly, descriptive analysis was performed to compare features of patients who had a CVE and patients who did not. Subsequently, inferential statistical analyses with ad-hoc proportional hazards models were performed to identify predictors of CVE.
Results Four hundred and nineteen patients were included in the study. Maximum follow-up length was 40 years. Demographic and disease features, as well as prevalence of traditional cardiovascular risk factors are shown in Table 1. Seventy-one (17%) patients had at least one CVE, whereas two different CVE were observed in nine (2%) cases. Forty (12%) patients had venous thrombosis, 26 (6%) had stroke, and 14 (3%) had coronary disease. Mean time to CVE was 14 (SD 8) years. While both diabetes and antiphospolipid antibodies positivity were associated with the outcome at univariable analysis (figure 1), multivariable analysis showed that only antiphospholipid predicted the occurrence of CVE (Hazard Ratio [HR] 2.95, 95% Confidence Interval [CI] 1.79 – 4.85, p-value < 0.001). Dedicated subanalyses showed that also cumulative dose of glucocorticoid (HR 1.0002, 95% CI 1.000003 – 1.000045, p-value=0.028) and Systemic Lupus International Collaborating Clinics Damage Index score (HR 1.47, 95% CI 1.15 – 1.88, p-value=0.002) were associated with CVE. While both venous thromboembolic events and strokes were predicted by antiphospholipid antibodies positivity (p-value < 0.001 and = 0.007, respectively), only male sex was associated with the specific diagnosis of coronary artery disease (p-value=0.002).
Descriptive comparative analysis of demographic and disease features between patients who had and patients who did not have a cardiovascular event
Survival curves of categorial variables associated with cardiovascular events at log-rank test. aPL, antiphospholipid andibodies; CVE, cardiovascular events
Conclusions Cardiovascular disease is highly prevalent in patients with SLE and is strongly associated with anti-phospholipid antibodies positivity, glucocorticoid therapy, and damage.
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