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Atherosclerotic Vascular Events in a Single Large Lupus Cohort: Prevalence and Risk Factors

MURRAY B. UROWITZ, DOMINIQUE IBAÑEZ, and DAFNA D. GLADMAN

ABSTRACT.

Objective. To determine prevalence and type of atherosclerotic vascular events (AVE) occurring after entry to the University of Toronto Lupus Clinic; and to compare risk factors in patients with systemic lupus erythematosus (SLE) with AVE to matched SLE controls without AVE.

Methods. Patients with SLE attending the University of Toronto Lupus Clinic who did not have AVE prior to clinic entry were included. Patients have been followed at 2–6 months since 1970 according to a standard protocol. Cases with AVE were matched for sex, era at first clinic visit (1970s, 1980s, 1990s ), inception status, age at first visit, and duration of followup. Chi-square, Fisher's exact, paired T test, and McNemar test were used. Comparison of risk factors for the development of AVE was done using a stepwise conditional logistic regression model for matched pairs.

Results. In a total cohort of 1087 SLE patients followed from 1970 until 2004, the prevalence of AVE was 10.9%, and in 561 inception patients it was 9.6%. In multivariate analyses, neuropsychiatric involvement was significantly associated with AVE in both the total and inception cohorts. Smoking was also associated with AVE in the inception cohort, whereas the number of coronary artery disease (CAD) risk factors and vasculitis were significant in the total cohort.

Conclusion. AVE are major contributors to the clinical presentation of late-stage lupus. A combination of lupus related factors and classic CAD risk factors contributed to the development of AVE. (First Release Nov 15 2006; J Rheumatol 2007;34:70–5)

Key Indexing Terms:

ATHEROSCLEROTIC VASCULAR EVENTS
SYSTEMIC LUPUS ERYTHEMATOSUS

RISK FACTORS
CORONARY ARTERY DISEASE


From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.

Supported by The Arthritis Society, Canadian Institutes for Health Research, and the Krembil Foundation.

M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Director, Centre for Prognosis Studies in the Rheumatic Diseases; D. Ibañez, MSc, Biostatistician, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Centre for Prognosis Studies in the Rheumatic Diseases.

Address reprint requests to Dr. M. Urowitz, Toronto Western Hospital, 399 Bathurst Street, 1E-410B, Toronto, Ontario M5T 2S8. E-mail: m.urowitz@utoronto.ca

Accepted for publication August 29, 2006.




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