TY - JOUR
T1 - Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus
AU - Magder, Laurence S.
AU - Petri, Michelle
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2012/10/15
Y1 - 2012/10/15
N2 - Patients with systemic lupus erythematosus (SLE) are at excess risk of cardiovascular events (CVEs). There is uncertainty regarding the relative importance of SLE disease activity, medications, or traditional risk factors in this increased risk. To gain insight into this, the authors analyzed data from a cohort of 1,874 patients with SLE who were seen quarterly at a single clinical center (April 1987-June 2010) using pooled logistic regression analysis. In 9,485 person-years of follow-up, the authors observed 134 CVEs (rate 14.1/1,000 person-years). This was 2.66 times what would be expected in the general population based on Framingham risk scores (95 confidence interval: 2.16, 3.16). After adjustment for age, CVE rates were not associated with duration of SLE. However, they were associated with average past levels of SLE disease activity and recent levels of circulating anti-double-stranded DNA. Past use of corticosteroids (in the absence of current use) was not associated with CVE rates. However, persons currently using 20 mg/day or more of corticosteroids had a substantial increase in risk even after adjustment for disease activity. Thus, consistent with findings in several recent publications among cohorts with other diseases, current use of corticosteroids was associated with an increased risk of CVEs. These results suggest a short-term impact of corticosteroids on CVE risk.
AB - Patients with systemic lupus erythematosus (SLE) are at excess risk of cardiovascular events (CVEs). There is uncertainty regarding the relative importance of SLE disease activity, medications, or traditional risk factors in this increased risk. To gain insight into this, the authors analyzed data from a cohort of 1,874 patients with SLE who were seen quarterly at a single clinical center (April 1987-June 2010) using pooled logistic regression analysis. In 9,485 person-years of follow-up, the authors observed 134 CVEs (rate 14.1/1,000 person-years). This was 2.66 times what would be expected in the general population based on Framingham risk scores (95 confidence interval: 2.16, 3.16). After adjustment for age, CVE rates were not associated with duration of SLE. However, they were associated with average past levels of SLE disease activity and recent levels of circulating anti-double-stranded DNA. Past use of corticosteroids (in the absence of current use) was not associated with CVE rates. However, persons currently using 20 mg/day or more of corticosteroids had a substantial increase in risk even after adjustment for disease activity. Thus, consistent with findings in several recent publications among cohorts with other diseases, current use of corticosteroids was associated with an increased risk of CVEs. These results suggest a short-term impact of corticosteroids on CVE risk.
KW - angina pectoris
KW - coronary artery bypass surgery
KW - intermittent claudication
KW - lupus erythematosus, systemic
KW - myocardial infarction, prednisone
KW - risk factors
KW - stroke
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U2 - 10.1093/aje/kws130
DO - 10.1093/aje/kws130
M3 - Article
C2 - 23024137
AN - SCOPUS:84867726569
VL - 176
SP - 708
EP - 719
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology
SN - 0002-9262
IS - 8
ER -