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

Urowitz MB, Gladman DD, Anderson NM, Su J, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke A, Bernatsky S, Gordon C, Hanly JG, Wallace DJ, Isenberg D, Rahman A, Merrill J, Ginzler E, Alarcón GS, Fessler BF, Petri M, Bruce IN, Khamashta M, Aranow C, Dooley M, Manzi S, Ramsey-Goldman R, Sturfelt G, Nived O, Steinsson K, Zoma A, Ruiz-Irastorza G, Lim S, Kalunian KC, Ỉnanç M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken C, Askanase A, Stoll T - Lupus Sci Med (2016)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.

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.

No MeSH data available.


Related in: MedlinePlus

Evolution of benign autoimmunity and early atherosclerosis to clinical disease. SLE, systemic lupus erythematosus.
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LUPUS2015000143F2: Evolution of benign autoimmunity and early atherosclerosis to clinical disease. SLE, systemic lupus erythematosus.

Mentions: These findings raise the question as to the relationship between atherosclerotic events and SLE. For atherosclerosis and SLE, the clinical event is obviously preceded by pathogenic mechanisms over a few years. It has been shown that autoantibodies develop in patients with SLE many years before the clinical recognition of the disease.25 This could lead to subclinical autoimmunity which subsequently manifests as a clinical diagnosis of SLE (figure 2). Similarly, inflammatory and metabolic mechanisms develop in patients with atherosclerosis before any evidence for clinical disease (MI, angina).26 It is therefore possible that subclinical autoimmunity may result in subclinical atherosclerosis and either can manifest itself clinically as the initial clinical presentation.27 Alternatively, the two mechanisms, autoimmunity and atherosclerosis, may develop independently but concurrently and may manifest themselves clinically at different times. This may be due to either a common genetic predisposition to both conditions or independent genetic factors interacting through epigenetic or environmental influences.


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

Urowitz MB, Gladman DD, Anderson NM, Su J, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke A, Bernatsky S, Gordon C, Hanly JG, Wallace DJ, Isenberg D, Rahman A, Merrill J, Ginzler E, Alarcón GS, Fessler BF, Petri M, Bruce IN, Khamashta M, Aranow C, Dooley M, Manzi S, Ramsey-Goldman R, Sturfelt G, Nived O, Steinsson K, Zoma A, Ruiz-Irastorza G, Lim S, Kalunian KC, Ỉnanç M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken C, Askanase A, Stoll T - Lupus Sci Med (2016)

Evolution of benign autoimmunity and early atherosclerosis to clinical disease. SLE, systemic lupus erythematosus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836282&req=5

LUPUS2015000143F2: Evolution of benign autoimmunity and early atherosclerosis to clinical disease. SLE, systemic lupus erythematosus.
Mentions: These findings raise the question as to the relationship between atherosclerotic events and SLE. For atherosclerosis and SLE, the clinical event is obviously preceded by pathogenic mechanisms over a few years. It has been shown that autoantibodies develop in patients with SLE many years before the clinical recognition of the disease.25 This could lead to subclinical autoimmunity which subsequently manifests as a clinical diagnosis of SLE (figure 2). Similarly, inflammatory and metabolic mechanisms develop in patients with atherosclerosis before any evidence for clinical disease (MI, angina).26 It is therefore possible that subclinical autoimmunity may result in subclinical atherosclerosis and either can manifest itself clinically as the initial clinical presentation.27 Alternatively, the two mechanisms, autoimmunity and atherosclerosis, may develop independently but concurrently and may manifest themselves clinically at different times. This may be due to either a common genetic predisposition to both conditions or independent genetic factors interacting through epigenetic or environmental influences.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.

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.

No MeSH data available.


Related in: MedlinePlus