Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Atherosclerotic Vascular Events in a Multinational Inception Cohort of SLE: Description and Attribution over an 8 Year Period.

Urowitz33,  Murray B., Gladman22,  Dafna D., Ibanez32,  Dominique, Gordon29,  Caroline P., Bae6,  Sang-Cheol, Clarke15,  Ann E., Bernatsky15,  Sasha R.

West Hollywood, CA
Kantonsspital Schaffhausen, Schaffhausen, Switzerland
Karolinska University Hospital, Sweden
Landspitalinn University Hospital, Iceland
Manchester Royal Infirmary, Manchester, United Kingdom
Medical University of South Carolina, Charleston, SC
Montreal General Hospital, Montreal, QC, Canada
North West Whales NHS Trust, Colwyn Bay, United Kingdom
Northwestern University, Chicago, IL
Oklahoma Med Research Foundation, Oklahoma City, OK
Queen Elizabeth II Health Services Center, Halifax, NS, Canada
Timonium, MD
SUNY-Downstate Medical Center, Brooklyn, NY
The Rayne Institute, London, United Kingdom
Toronto Western Hospital, Toronto, ON, Canada
UAB Rheumatology, Birmingham, AL
UCL Div of Medicine, London, United Kingdom
UCL Div of Medicine, United Kingdom
UCSD School of Medicine, La Jolla, CA
University Hospital Lund, Lund, Sweden
University of Alabama, Oakland, CA
University of Birmingham, Birmingham, United Kingdom
Emory University, Atlanta, GA
University of Manitoba, Winnipeg, MB, Canada
University of North Carolina, Chapel Hill, NC
University of Toronto Lupus Clinic, Toronto Western Hospital
University of Toronto Lupus Clinic, Toronto Western Hospital, Toronto, ON, Canada
West Penn Allegheny Health System, Pittsburgh, PA
Feinstein Institute, Manhasset, NY
Hairmyres Hospital, East Kilbride, United Kingdom
Hanyang University Medical Center, Seoul, Korea, Republic of
Hospital Clinico I Provincial, Spain
Hospital de Cruces, Universidad del Pais Vasco, Spain
Instituto Nacional Nutricion, Mexico City, DF, Mexico

A large mutlicentre multinational inception cohort was established to study risk factors for atherosclerosis (AS) in SLE. This study describes vascular events during 10 years of follow-up and their attribution to AS.

Methods:

Patients enter the cohort within 15 months of SLE diagnosis (>=4 ACR criteria). Clinical and laboratory features of SLE and comorbidities are gathered in a standardized protocol at yearly intervals. Vascular events are described and attributed on a specialized form. Events recorded include myocardial infarction (MI), angina, congestive heart failure (CHF), intermittent claudication (PVD), stroke, transient ischemic attack (TIA). Diagnosis of an event was confirmed using standard clinical criteria, relevant laboratory data and imaging where appropriate. Attribution to AS was made on the basis of lupus disease being inactive at the time of the event, and/or the presence of typical AS changes on imaging or pathology and/or evidence of AS elsewhere. Factors associated with AVE were analysed using descriptive statistics, t-tests and c2.

Results:

Since 2000, 1593 patients have been entered into the cohort (89%F, age at SLE 35y, mean followup of 3.7 years). Thus far there have been 134 vascular events in 96 patients. These include: MI (16), angina (17), CHF (32), PVD (10), TIA (21) stroke (33), pacemaker insertion (5). 70 of the events were attributed to active lupus and 20 to other causes and 4 were unknown. 40 events in 26 patients were attributed to AS including: MI (8), angina (14), CHF (6), PVD (6), TIA (3), pacemaker (2), stroke (1).

Ten patients in the AS group had more than one event. Lupus duration at AS event was 2.7 ± 2.4 years. Compared to patients followed for 3 years without vascular events (n=770), at enrolment, patients with AS events were more frequently male (42% vs. 11% p <0.0001) were older at diagnosis (54 ± 13 vs. 34 ± 13, p<0.0001), more frequently had hypertension (65% vs. 32% p=0.0003), and were more often obese (52% vs 30% p=0.02). While hypercholesterolemia, diabetes, smoking and family history of CAD were more common among those with AS events than those without, the difference was not statistically significant. There was no difference in proportion of Caucasian versus other ethnicities in the two groups.

Conclusion:

Over the follow-up of an inception cohort with SLE there were 134 vascular events but only 40 were attributable to AS. Patients with AS events were more likely to be male, older age at diagnosis, more frequently obese and more often had hypertension.

To cite this abstract, please use the following information:
Urowitz, Murray B., Gladman, Dafna D., Ibanez, Dominique, Gordon, Caroline P., Bae, Sang-Cheol, Clarke, Ann E., et al; Atherosclerotic Vascular Events in a Multinational Inception Cohort of SLE: Description and Attribution over an 8 Year Period. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :448
DOI: 10.1002/art.28217

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