Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Development of Atherosclerotic Vascular Events in Systemic Lupus Erythematosus: How Important Are Race/Ethnicity and Geography?

Urowitz1,  Murray B., Gladman1,  D. D., Ibanez1,  Dominique, Anderson1,  Nicole, Systemic Lupus International Collaborating Clinics (SLICC),  

Toronto Western Hospital and University of Toronto, Toronto, ON

Background/Purpose:

We have previously demonstrated that there are differences at inception in the atherosclerotic disease related risk factors for the development of AVE in SLE when studied by geographic and race/ethnicity origins. In this study we examined the influences of race/ethnicity and geography on the development of AVEs attributed to atherosclerosis (AS) in patients with SLE followed from inception.

Methods:

An international research network comprising 27 centres from 11 countries has followed an inception cohort of SLE patients yearly according to a standardized protocol between 2000 and 2011. 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. Predictor factors for AVE at enrolment included age, sex, SLEDAI-2K, hypercholesterolemia, hypertension, diabetes, metabolic syndrome (MetS), geography, and race/ethnicity. Univariate and multivariate analyses were performed.

Results:

1332 patients have been entered into the inception cohort with at least 1 year followup. Of those 24 had AVEs attributed to AS (angina 10, MI 3, claudication 4, TIA 3, pace maker 2 congestive heart failure 1, stroke 1). In univariate analyses older age at diagnosis, male sex, hypertension, hypercholesterolemia, diabetes, metabolic syndrome at inception were predictive for AVE. Neither individual geographic regions, nor individual race/ethnicities were predictive in univariate analyses. However, AVEs occurred more commonly among Caucasians when compared to other race/ethnicities combined (log rank p=0.002). Caucasians were significantly older then non-Caucasians at SLE diagnosis (38.3±14.5 compared to 31.0±11.2, p<0.0001) On multivariate regression analysis adjusting for age at diagnosis, sex, SLEDAI-2K, hypercholesterolemia, hypertension and diabetes, only older age at SLE diagnosis (HR = 1.06, 95% CI (1.03, 1.10), p=0.0002) and Male Sex (HR=3.58 95% CI (1.40, 9.17), p=0.008) remained statistically significantly associated with AVE.

Conclusion:

These analyses were unable to establish important influences of geographic region and individual race/ethnicities with respect to AVEs in patients with SLE.

To cite this abstract, please use the following information:
Urowitz, Murray B., Gladman, D. D., Ibanez, Dominique, Anderson, Nicole, Systemic Lupus International Collaborating Clinics (SLICC), ; Development of Atherosclerotic Vascular Events in Systemic Lupus Erythematosus: How Important Are Race/Ethnicity and Geography? [abstract]. Arthritis Rheum 2011;63 Suppl 10 :785
DOI:

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