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.

Methods:

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 3–6 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.

Results:

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 1.05–336.3, P = 0.02). Calcium scores in 9 patients ranged between >0–20, and in the remaining patient 402; in the positive control it was 239. Calcifications in lupus patients were detected since age 21–30 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.

Conclusions:

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
DOI: 10.1002/art.28228

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