PT  - JOURNAL ARTICLE
AU  - Mandana Nikpour
AU  - Dafna D.  Gladman
AU  - Dominique Ibanez
AU  - Paula J.  Harvey
AU  - Murray B.  Urowitz
TI  - Assessment of Coronary Risk Based on Cumulative Exposure to Lipids in Systemic Lupus Erythematosus
AID  - 10.3899/jrheum.121273
DP  - 2013 Oct 15
TA  - The Journal of Rheumatology
PG  - jrheum.121273
4099  - http://www.jrheum.org/content/early/2013/10/09/jrheum.121273.short
4100  - http://www.jrheum.org/content/early/2013/10/09/jrheum.121273.full
AB  - Objective To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE). Methods Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient. Time-dependent proportional hazards regression models were used to quantify the risk of coronary event [myocardial infarction (MI) or angina], after adjustment for age. Results Among 384 patients, over a mean (SD) followup of 3.81 (2.58) years, there were 21 “first” coronary events (6 MI, 15 angina). Mean and TAM LDL-C (HR 1.83, 95% CI 1.19–2.81, p = 0.006), TC:HDL ratio (HR 1.43, 95% CI 1.02–2.00, p = 0.04), and TG (HR 2.11, 95% CI 1.32–3.39, p = 0.0019) were predictive of coronary event at subsequent visits. In contingency table analysis, TAM LDL-C cutpoint of 2.0 mmol/l had a sensitivity and negative predictive value for coronary event of 85.7% (95% CI 63.7–97.0) and 93.9% (95% CI 83.1–98.7), respectively. However, at this cutpoint the specificity was only 12.7% (95% CI 9.4–16.5). Conclusion This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.