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

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

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.

PubMed Disclaimer

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

Cited by

Lupus nephritis as an independent risk factor for carotid atherosclerosis in patients with systemic lupus erythematosus.
Wang Y, Guo S, Shi Y, Wei X, Chen W, Zhang Y, Yuan X, Sun L. Wang Y, et al. Clin Rheumatol. 2025 May;44(5):1927-1937. doi: 10.1007/s10067-025-07413-z. Epub 2025 Mar 26. Clin Rheumatol. 2025. PMID: 40138152
Personalizing cardiovascular risk prediction for patients with systemic lupus erythematosus.
Choi MY, Guan H, Yoshida K, Paudel M, Kargere BA, Li D, Ellrodt J, Stevens E, Cai T, Weber BN, Everett BM, Costenbader KH. Choi MY, et al. Semin Arthritis Rheum. 2024 Aug;67:152468. doi: 10.1016/j.semarthrit.2024.152468. Epub 2024 May 17. Semin Arthritis Rheum. 2024. PMID: 38788567 Free PMC article.
Serum Resistin Level and Progression of Atherosclerosis during Glucocorticoid Therapy for Systemic Autoimmune Diseases.
Tanaka N, Masuoka S, Kusunoki N, Nanki T, Kawai S. Tanaka N, et al. Metabolites. 2016 Sep 16;6(3):28. doi: 10.3390/metabo6030028. Metabolites. 2016. PMID: 27649254 Free PMC article.
Damage in a large systemic lupus erythematosus cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER) with emphasis on the cardiovascular system: a longitudinal analysis.
Altabás-González I, Rua-Figueroa I, Mouriño C, Roberts K, Jimenez N, Martinez-Barrio J, Galindo M, Calvo Alén J, Pérez VDC, Uriarte Itzazelaia E, Tomero E, Freire-González M, Martínez Taboada V, Salgado E, Vela P, Fernandez-Nebro A, Olivé A, Narváez J, Menor-Almagro R, Soler GS, Hernández-Beriain JÁ, Manero J, Aurrecoechea E, Ibarguengoitia-Barrena O, Montilla C, Bonilla G, Torrente-Segarra V, Cacheda AP, García-Villanueva MJ, Moriano-Morales C, Manteca CF, Lozano-Rivas N, Bohórquez C, Pego-Reigosa JM. Altabás-González I, et al. Lupus Sci Med. 2024 Aug 3;11(2):e001064. doi: 10.1136/lupus-2023-001064. Lupus Sci Med. 2024. PMID: 39097409 Free PMC article.
High Burden of Premature Arteriosclerosis on Renal Biopsy Results in Incident Lupus Nephritis.
Garg S, Bartels CM, Hansen KE, Zhong W, Huang Y, Semanik MG, Smith M, Panzer SE. Garg S, et al. Arthritis Care Res (Hoboken). 2021 Mar;73(3):394-401. doi: 10.1002/acr.24138. Arthritis Care Res (Hoboken). 2021. PMID: 31909878 Free PMC article.

See all "Cited by" articles

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

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources

Other Literature Sources

Erratum in

Abstract

Figures

Similar articles

Cited by

References

Related information

LinkOut - more resources

Full Text Sources

Other Literature Sources