RT Journal Article
SR Electronic
T1 Atherosclerotic Vascular Events in Systemic Lupus Erythematosus – an Evolving Story
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.180986
DO 10.3899/jrheum.180986
A1 Murray B.  Urowitz
A1 Jiandong Su
A1 Dafna D.  Gladman
YR 2019
UL http://www.jrheum.org/content/early/2019/01/23/jrheum.180986.abstract
AB Objective Atherosclerotic vascular events (AVEs) are a major cause of mortality and morbidity in systemic lupus erythematosus (SLE). We aimed to determine the impact of early recognition and therapy for both classic risk factors for AVE and for SLE on the burden of AVEs in lupus in recent decades. Methods Inception patients who entered the University of Toronto lupus Clinic between 1975 and 1987 followed to 1992 (Cohort 1) and between 1999 and 2011 followed to 2016 (Cohort 2) were studied. AVEs, attributed to atherosclerosis, and occurring during the 17 years were identified. Lupus disease activity and therapy as well as hypertension, hypercholesterolemia, hyperglycemia and smoking were assessed. Analysis included descriptive statistics on baseline characteristics, traditional risk factors over the follow up, outcome rates by each 100 person years; Kaplan-Meier cumulative AVE curves, as well as competing risk Cox models adjusted by Inverse Probability Weights (IPW). Results Of the 234 in Cohort 1, 26 patients (11%) had an AVE compared with 10 of 262 (3.8%) in Cohort 2. The rate per 100 patient-years of follow-up was 1.8 in Cohort 1 and 0.44 in Cohort 2 (P < 0.0001). Better control of all risk factors and disease activity were achieved in Cohort 2. There was a reduction of 60% in the risk for AVE in cohort 2. Conclusion The incidence of AVE in SLE in the modern era has declined in large part due to more effective management of classic coronary artery risk factors and of SLE.