Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort

M B Urowitz¹, D D Gladman¹, N M Anderson¹, J Su¹, J Romero-Diaz², S C Bae³, P R Fortin⁴, J Sanchez-Guerrero¹, A Clarke⁵, S Bernatsky⁶, C Gordon⁷, J G Hanly⁸, D J Wallace⁹, D Isenberg¹⁰, A Rahman¹⁰, J Merrill¹¹, E Ginzler¹², G S Alarcón¹³, B F Fessler¹³, M Petri¹⁴, I N Bruce¹⁵, M Khamashta¹⁶, C Aranow¹⁷, M Dooley¹⁸, S Manzi¹⁹, R Ramsey-Goldman²⁰, G Sturfelt²¹, O Nived²¹, K Steinsson²², A Zoma²³, G Ruiz-Irastorza²⁴, S Lim²⁵, K C Kalunian²⁶, M Ỉnanç²⁷, R van Vollenhoven²⁸, M Ramos-Casals²⁹, D L Kamen³⁰, S Jacobsen³¹, C Peschken³², A Askanase³³, T Stoll³⁴

Affiliations

¹ Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.
² Instituto Nacional de Ciencias Medicas y Nutrición , Mexico City , Mexico.
³ Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Korea.
⁴ Division of Rheumatology , Centre Hospitalier Universitaire de Québec et Université Laval , Quebec City , Canada.
⁵ Division of Rheumatology , Cumming School of Medicine University of Calgary , Calgary, Alberta , Canada.
⁶ Divisions of Clinical Immunology/Allergy and Clinical Epidemiology , Montreal General Hospital, McGill University Health Centre , Montreal, Quebec , Canada.
⁷ Rheumatology Research Group , School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK.
⁸ Division of Rheumatology, Department of Medicine and Department of Pathology , Queen Elizabeth II Health Sciences Centre and Dalhousie University , Halifax, Nova Scotia , Canada.
⁹ Cedars-Sinai/David Geffen School of Medicine at UCLA , Los Angeles, California , USA.
¹⁰ Centre for Rheumatology Research, University College , London , UK.
¹¹ Department of Clinical Pharmacology , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA.
¹² Department of Medicine , SUNY Downstate Medical Center , Brooklyn, New York , USA.
¹³ Department of Medicine, Division of Clinical Immunology and Rheumatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
¹⁴ Department of Rheumatology , Johns Hopkins University School of Medicine , Baltimore, Maryland , USA.
¹⁵ Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, London, UK.
¹⁶ Lupus Research Unit , The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine , London , UK.
¹⁷ Feinstein Institute for Medical Research , Manhasset, New York , USA.
¹⁸ Division of Rheumatology and Immunology, Department of Medicine , University of North Carolina , Chapel Hill, North Carolina , USA.
¹⁹ Department of Medicine , West Penn Allegheny , Pittsburgh, Pennsylvania , USA.
²⁰ Northwestern University and Feinberg School of Medicine , Chicago, Illinois , USA.
²¹ Department of Rheumatology , University Hospital Lund , Lund , Sweden.
²² Department of Rheumatology , Center for Rheumatology Research Fossvogur Landspitali University Hospital , Reyjkavik , Iceland.
²³ Lanarkshire Centre for Rheumatology, Hairmyres Hospital , East Kilbride, Scotland , UK.
²⁴ Autoimmune Disease Unit, Department of Internal Medicine , Hospital Universitario Cruces., University of the Basque Country , Barakaldo , Spain.
²⁵ Division of Rheumatology, Emory University School of Medicine , Atlanta, Georgia , USA.
²⁶ UCSD School of Medicine , La Jolla, California , USA.
²⁷ Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey.
²⁸ Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute , Stockholm , Sweden.
²⁹ Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases , Hospital Clínic , Barcelona , Spain.
³⁰ Division of Rheumatology, Medical University of South Carolina , Charleston, South Carolina , USA.
³¹ Department of Rheumatology Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark.
³² Department of Medicine and Community Health Sciences, University of Manitoba , Winnipeg, Manitoba , Canada.
³³ Division of Rheumatology, Columbia University Medical Center , New York , USA.
³⁴ Department of Rheumatology , Kantousspital , Schaffhausen , Switzerland.

PMID: 27099765
PMCID: PMC4836282
DOI: 10.1136/lupus-2015-000143

Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort

M B Urowitz et al. Lupus Sci Med. 2016.

. 2016 Apr 12;3(1):e000143.

doi: 10.1136/lupus-2015-000143. eCollection 2016.

Authors

Affiliations

¹ Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.
² Instituto Nacional de Ciencias Medicas y Nutrición , Mexico City , Mexico.
³ Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Korea.
⁴ Division of Rheumatology , Centre Hospitalier Universitaire de Québec et Université Laval , Quebec City , Canada.
⁵ Division of Rheumatology , Cumming School of Medicine University of Calgary , Calgary, Alberta , Canada.
⁶ Divisions of Clinical Immunology/Allergy and Clinical Epidemiology , Montreal General Hospital, McGill University Health Centre , Montreal, Quebec , Canada.
⁷ Rheumatology Research Group , School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK.
⁸ Division of Rheumatology, Department of Medicine and Department of Pathology , Queen Elizabeth II Health Sciences Centre and Dalhousie University , Halifax, Nova Scotia , Canada.
⁹ Cedars-Sinai/David Geffen School of Medicine at UCLA , Los Angeles, California , USA.
¹⁰ Centre for Rheumatology Research, University College , London , UK.
¹¹ Department of Clinical Pharmacology , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA.
¹² Department of Medicine , SUNY Downstate Medical Center , Brooklyn, New York , USA.
¹³ Department of Medicine, Division of Clinical Immunology and Rheumatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
¹⁴ Department of Rheumatology , Johns Hopkins University School of Medicine , Baltimore, Maryland , USA.
¹⁵ Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, London, UK.
¹⁶ Lupus Research Unit , The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine , London , UK.
¹⁷ Feinstein Institute for Medical Research , Manhasset, New York , USA.
¹⁸ Division of Rheumatology and Immunology, Department of Medicine , University of North Carolina , Chapel Hill, North Carolina , USA.
¹⁹ Department of Medicine , West Penn Allegheny , Pittsburgh, Pennsylvania , USA.
²⁰ Northwestern University and Feinberg School of Medicine , Chicago, Illinois , USA.
²¹ Department of Rheumatology , University Hospital Lund , Lund , Sweden.
²² Department of Rheumatology , Center for Rheumatology Research Fossvogur Landspitali University Hospital , Reyjkavik , Iceland.
²³ Lanarkshire Centre for Rheumatology, Hairmyres Hospital , East Kilbride, Scotland , UK.
²⁴ Autoimmune Disease Unit, Department of Internal Medicine , Hospital Universitario Cruces., University of the Basque Country , Barakaldo , Spain.
²⁵ Division of Rheumatology, Emory University School of Medicine , Atlanta, Georgia , USA.
²⁶ UCSD School of Medicine , La Jolla, California , USA.
²⁷ Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey.
²⁸ Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute , Stockholm , Sweden.
²⁹ Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases , Hospital Clínic , Barcelona , Spain.
³⁰ Division of Rheumatology, Medical University of South Carolina , Charleston, South Carolina , USA.
³¹ Department of Rheumatology Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark.
³² Department of Medicine and Community Health Sciences, University of Manitoba , Winnipeg, Manitoba , Canada.
³³ Division of Rheumatology, Columbia University Medical Center , New York , USA.
³⁴ Department of Rheumatology , Kantousspital , Schaffhausen , Switzerland.

PMID: 27099765
PMCID: PMC4836282
DOI: 10.1136/lupus-2015-000143

Erratum in

Erratum: Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort.
[No authors listed] [No authors listed] Lupus Sci Med. 2016 May 12;3(1):e000143corr1. doi: 10.1136/lupus-2015-000143corr1. eCollection 2016. Lupus Sci Med. 2016. PMID: 27335658 Free PMC article.

Abstract

Objective: To describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up.

Methods: The systemic lupus international collaborating clinics (SLICC) atherosclerosis inception cohort enters patients within 15 months of SLE diagnosis. MIs were reported and attributed on a specialised vascular event form. MIs were confirmed by one or more of the following: abnormal ECG, typical or atypical symptoms with ECG abnormalities and elevated enzymes (≥2 times upper limit of normal), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used.

Results: 31 of 1848 patients who entered the cohort had an MI. Of those, 23 patients had an MI prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied, 60.9% were female, 78.3% were Caucasian, 8.7% black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5±15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1±7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up. Risk factors associated with early MI in univariate analysis are male sex, Caucasian, older age at diagnosis, hypertension, hypercholesterolaemia, family history of MI and smoking. In multivariate analysis only age (OR=1.06 95% CI 1.03 to 1.09), hypertension (OR=5.01, 95% CI 1.38 to 18.23), hypercholesterolaemia (OR=4.43, 95% CI 1.51 to 12.99) and smoking (OR=7.50, 95% CI 2.38 to 23.57) remained significant risk factors.

Conclusions: In some patients with lupus, MI may develop even before the diagnosis of SLE or shortly thereafter, suggesting that there may be a link between autoimmune inflammation and atherosclerosis.

Keywords: Cardiovascular Disease; Inflammation; Systemic Lupus Erythematosus.

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Figures

**Figure 1**
23 myocardial infarction (MI) events occurred prior to or in the first 2 years in 1848 patients. Age at MI is indicated by the number below each bar.

**Figure 2**
Evolution of benign autoimmunity and early atherosclerosis to clinical disease. SLE, systemic lupus erythematosus.

See this image and copyright information in PMC

References

1. Urowitz MB, Gladman DD, Tom BD et al. Changing patterns in mortality and disease outcome for patients with systemic lupus erythematosus. J Rheumatol 2008;35:2152–8. doi:10.3899/jrheum.080214 - DOI - PubMed
1. Yukovich M, Vostretsova K, Chen W et al. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res (Hoboken) 2014;66:608–16. doi:10.1002/acr.22173 - DOI - PubMed
1. Abu-Shakra M, Urowitz MB, Gladman DD et al. Mortality studies in systemic lupus erythematosus. Results from a single centre. I. Causes of death. J Rheumatol 1995;22:1259–64. - PubMed
1. Urowitz MB, Bookman AA, Koehler BE et al. The bimodal mortality in systemic lupus erythematosus. Am J Med 1976;60:221–5. doi:10.1016/0002-9343(76)90431-9 - DOI - PubMed
1. Manzi S, Meilahn EN, Rairie JE et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997;145:408–5. doi:10.1093/oxfordjournals.aje.a009122 - DOI - PubMed

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Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort

Affiliations

Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort

Authors

Affiliations

Erratum in

Abstract

Figures

References

LinkOut - more resources

Full Text Sources

Other Literature Sources