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.
Effects of Disease Activity and Use of Antimalarials on the Risk of Coronary-Artery Calcifications in SLE Patients.
Romero-Diaz3, Juanita, Vargas-Worackova1, Florencia, Kimura-Hayama2, Eric, Aguilar-Salinas3, Carlos, Sanchez-Guerrero4, Jorge
Instituto Nacional ce Ciencias Medicas y Nutricion Salvador Zubiran
Instituto Nacional de Cardiologia Ignacio Chavez
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico
Traditional cardiovascular risk-factors do not fully explain premature atherosclerosis in SLE. We aimed to identify lupus-related factors associated with coronary-artery calcifications in an inception cohort for the study of atherosclerosis.
We included 139 patients (93% females) with SLE of recent-onset at enrollment, w/o preexisting coronary heart disease. At enrollment, a standardized medical evaluation was done assessing lupus characteristics, medications, cardiovascular risk-factors, and laboratory tests (lipid profile, homocystein, hsCRP, autoantibodies). Patients were seen every 36 months, and assessed for disease activity and medications. Every year, information was updated and a blood sample drawn.
At 5.5 ± 2.9 years of follow-up, all the 139 patients and 100 healthy subjects, matched for age and sex, were screened for coronary-artery calcifications using a 64-slice Multidetector Computed Tomography.
A nested analysis of lipids and inflammatory molecules was conducted among all lupus patients with calcifications and a random sample without calcifications (ratio 1:4), matched for age, sex and disease duration. Measurements were done in samples drawn at enrollment, mid follow-up, and at screening: total cholesterol, cHDL, cLDL, triglycerides, Lp(a) lipoprotein, and Apo B; CD40 ligand, IL-6, IP-10, MCP-1, sICAM-1, vCAM-1 (ELISA). Also, fasting levels of homocystein, and hsCRP were determined at enrollment and at screening.
At enrollment, mean (SD) age of lupus patients was 27.2 (9.1) years, lupus duration 5.4 (3.8) months, and SLEDAI-2K score 6.9 (5.8). At screening for calcification, mean age of patients and controls was similar (31.8 ± 8.8 vs. 32.2 ± 9.8 years), as most cardiovascular risk-factors; however lupus patients had more often hypertension, higher levels of homocystein and hsCRP, wider waist, and females were more often post-menopausal, P<0.05.
Coronary-calcifications were detected in 10 patients (7.2%) and 1 control (OR 7.7, 95% CI 1.05336.3, P = 0.02). Calcium scores in 9 patients ranged between >020, and in the remaining patient 402; in the positive control it was 239. Calcifications in lupus patients were detected since age 2130 years and from 3 years of diagnosis.
In comparison to patients w/o calcifications, patients with calcifications were older, females more often postmenopausal, had higher Apo-B levels, IgG aPL antibodies, and the Framingham risk-scores were higher (p<0.05). Disease activity along the course of lupus was higher (SLEDAI-2K AUC 20.3±8.3 vs. 13.7±8.3, P=0.02), and the period of moderate/severe activity longer (SLEDAI-2K score >=7, 20.0±18.3 vs. 8.0±12.5 months, P=0.006). Cumulative doses of prednisone and cyclophosphamide were higher (P<0.05), but use of antimalarials lower (20% vs 65%, P=0.006). Longitudinal analyses of lipids, cytokines and chemokines did not show differences. Logistic regression analysis showed an independent association of age, Apo-B, lupus activity (P=0.004), and use of antimalarials (P=0.008) with calcifications.
Lupus activity is an independent risk factor for coronary-artery calcifications, a risk that might be reduced using antimalarials.
To cite this abstract, please use the following information:
Romero-Diaz, Juanita, Vargas-Worackova, Florencia, Kimura-Hayama, Eric, Aguilar-Salinas, Carlos, Sanchez-Guerrero, Jorge; Effects of Disease Activity and Use of Antimalarials on the Risk of Coronary-Artery Calcifications in SLE Patients. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :459