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.


SLE and Atherosclerotic Risk Factors by Ethnicity and Geographic Distribution at Inception in a International Cohort of SLE.

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

West Hollywood, CA
Kantansspital Schaffhausen, Schaffhausen, Switzerland
Karolinska University Hospital
Landspitalinn University Hospital
Manchester Royal Infirmary, Manchester, United Kingdom
Medical University of South Carolina, Charleston, SC
Montreal General Hospital, Montreal, QC, Canada
North West Wales NHS Trust, Colwyn Bay, United Kingdom
Northwestern University, Chicago, IL
Oklahoma Medical 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
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 at Chapel Hill, 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
Hospital de Cruces, Universidad del Pais Vasco
Instituto Nacional Nutricion, Mexico City, DF, Mexico

A large multicentre multinational inception cohort was established to study risk factors for atherosclerosis (AS) in SLE. We have previously shown that a significant number of atherosclerotic disease risk factors are present within the first year of SLE. This study examines the presence of SLE and atherosclerotic risk factors at inception in a multicenter, international cohort of SLE patients according to ethnic groups and by geographic distribution.

Methods:

30 centres from 11 countries assembled an inception cohort of SLE patients according to a standardized protocol between 2000 and 2010 to study risk factors for atherosclerosis. Simple statistics are provided. Comparisons between ethnic groups and geographic distributions were made using chi square tests and analysis of variance.

Results:

Of the inception cohort of 1593 SLE patients 89% were female and age at diagnosis was 35±13 yrs. Patient characteristics were as follows:

Table 1. Distribution by Geographical Area of Residence

 AsiaCanadaEuropeMexicoUSAP value
N168 (10.6)352 (22.1)425 (26.7)202 (12.7)446 (28.0) 
Sex F89%89%91%90%88%0.85
Age at diagnosis29 ± 1038 ± 1537 ± 1428 ± 936 ± 13<0.0001
SLEDAI-2K7.4 ± 6.16.3 ± 5.63.9 ± 5.06.8 ± 6.14.6 ± 4.5<0.0001
SDI0.25 ± 0.700.31 ± 0.700.16 ± 0.590.25 ± 0.560.41 ± 0.860.009
SF36 PCS43 ± 839 ± 1139 ± 1142 ± 1039 ± 11<0.0001
MCS44 ± 1145 ± 1244 ± 1245 ± 1245 ± 120.93
Hypertensive32%33%32%41%34%0.20
Cholesterolemia35%41%31%36%37%0.09
Current Smoker7%18%17%9%17%0.0004
Metabolic Syndrome8%12%11%25%15%<0.0001
Family History of CAD8%27%23%15%31%0.03
Steroids95%60%63%93%61%<0.0001
Antimalarial73%73%64%48%68%<0.0001
Immunosuppressive50%35%35%65%33%<0.0001

Table 2. Distribution by Ethnic Group

 AsianBlackCaucasianHispanicOtherP value
N257 (16.2)247 (15.2)772 (48.5)250 (15.7)65 (4.1) 
Sex F90%90%88%90%95%0.27
Age at diagnosis30 ± 1134 ± 1138 ± 1529 ± 1035 ± 14<0.0001
SLEDAI-2K7.1 ± 6.14.7 ± 5.04.5 ± 5.06.8 ± 5.95.7 ± 4.8<0.0001
SDI0.28 ± 0.730.37 ± 0.880.23 ± 0.600.29 ± 0.700.26 ± 0.810.44
SF36 PCS42 ± 937 ± 1138 ± 1140 ± 1037 ± 11<0.0001
MCS45 ± 1145 ± 1245 ± 1244 ± 1244 ± 110.97
Hypertensive31%48%30%38%25%<0.0001
Cholesterolemia37%43%33%34%41%0.06
Current Smoker7%13%20%9%27%<0.0001
Metabolic Syndrome7%14%13%22%15%0.0001
Family History of CAD18%32%24%23%46%0.07
Steroids89%79%53%88%67%<0.0001
Antimalarial71%61%70%52%61%<0.0001
Immunosuppressive47%43%30%60%42%<0.0001

SLEDAI-2K was higher in Asians and Hispanics and also in the geographical areas in which they are a majority. SDI on the other hand is not associated with ethnicity but is higher in the United States. Metabolic syndrome is higher in Mexicans and in Hispanics in general. Hypertension does not show a geographic distribution but is associated with Black ethnicity.

Conclusion:

There are differences in the features of SLE and atherosclerotic risk factors at inception when studied by geographic and ethnicity origins. Whether there will be differences in the development of CAD events among these ethnic groups remains to be elucidated.

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; SLE and Atherosclerotic Risk Factors by Ethnicity and Geographic Distribution at Inception in a International Cohort of SLE. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1877
DOI: 10.1002/art.29642

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