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Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort

Urowitz, Murray B. ; Gladman, Dafna D. ; Farewell, Vernon ; Su, Jiandong ; Romero-Diaz, Juanita ; Bae, Sang Cheol ; Fortin, Paul R. ; Sanchez-Guerrero, Jorge ; Clarke, Ann Elaine and Bernatsky, Sasha , et al. (2020) In Arthritis and Rheumatology 72(10). p.1734-1740
Abstract

Objective: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and... (More)

Objective: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. Results: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32–0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55–10.30]) and a body mass index of >40 kg/m2 (HR 2.74 [95% CI 1.04–7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17–9.27], P < 0.001). Conclusion: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Arthritis and Rheumatology
volume
72
issue
10
pages
7 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:32515554
  • scopus:85089782157
ISSN
2326-5191
DOI
10.1002/art.41392
language
English
LU publication?
yes
id
6e9f890b-67eb-45ac-975b-2b491c353f69
date added to LUP
2020-09-10 15:52:41
date last changed
2022-08-11 08:42:23
@article{6e9f890b-67eb-45ac-975b-2b491c353f69,
  abstract     = {{<p>Objective: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. Results: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32–0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55–10.30]) and a body mass index of &gt;40 kg/m<sup>2</sup> (HR 2.74 [95% CI 1.04–7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17–9.27], P &lt; 0.001). Conclusion: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.</p>}},
  author       = {{Urowitz, Murray B. and Gladman, Dafna D. and Farewell, Vernon and Su, Jiandong and Romero-Diaz, Juanita and Bae, Sang Cheol and Fortin, Paul R. and Sanchez-Guerrero, Jorge and Clarke, Ann Elaine and Bernatsky, Sasha and Gordon, Caroline and Hanly, John G. and Wallace, Daniel J. and Isenberg, David A. and Rahman, Anisur and Merrill, Joan T. and Ginzler, Ellen and Alarcón, Graciela S. and Chatham, W. Winn and Petri, Michelle A. and Bruce, Ian N. and Khamashta, Munther A. and Aranow, Cynthia and Dooley, Mary Anne and Manzi, Susan and Ramsey-Goldman, Rosalind and Nived, Ola and Jönsen, Andreas and Steinsson, Kristján and Zoma, Asad A. and Ruiz-Irastorza, Guillermo and Lim, S. Sam and Kalunian, Kenneth C. and Ỉnanç, Murat and van Vollenhoven, Ronald and Ramos-Casals, Manuel and Kamen, Diane L. and Jacobsen, Soren and Peschken, Christine A. and Askanase, Anca and Stoll, Thomas}},
  issn         = {{2326-5191}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1734--1740}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Arthritis and Rheumatology}},
  title        = {{Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort}},
  url          = {{http://dx.doi.org/10.1002/art.41392}},
  doi          = {{10.1002/art.41392}},
  volume       = {{72}},
  year         = {{2020}},
}