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Chuang YW, Yu MC, Lin CL, Yu TM, Shu KH, Kao CH. Risk of Peripheral Arterial Occlusive Disease in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e2121. [PMID: 26579830 PMCID: PMC4652839 DOI: 10.1097/md.0000000000002121] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is associated with atherosclerosis, but the relationship between SLE and peripheral arterial occlusive disease (PAOD) remains unclear. We sought to investigate this relationship by comparing cardiovascular complications in patients with and without SLE.Data on patients from 2000 to 2011 were collected from the National Health Insurance Research Database of Taiwan. The SLE cohort was frequency-matched according to age, sex, and history of diabetes mellitus (DM) with patients without SLE (control cohort). We evaluated the risk of cardiovascular complications, including hypertension, DM, stroke, chronic obstructive pulmonary disease, heart failure, coronary artery disease, and hyperlipidemia.The study included 10,144 patients with SLE and 10,144 control patients. The incidence of PAOD was 9.39-fold higher (95% confidence interval [CI] = 7.70-11.15) in the SLE cohort than in the non-SLE cohort. Moreover, SLE was an independent risk factor for PAOD. The adjusted risk of PAOD was highest in patients with SLE who were aged ≤34 years (hazard ratio = 47.6, 95% CI = 26.8-84.4). The risk of PAOD was highest during the first year of follow-up and decreased over time.Patients with SLE exhibit a higher incidence and an independently higher risk of PAOD compared with the general population. The PAOD risk is markedly elevated in patients with SLE who are young and in whom the disease is at an early stage.
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Affiliation(s)
- Ya-Wen Chuang
- From the Division of Nephrology, Taichung Veterans General Hospital, Taichung (Y-WC, T-MY, K-HS); Department of Pediatric Nephrology, Chang Gung Children's Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan (M-CY); Management Office for Health Data, China Medical University Hospital (C-LL); College of Medicine, China Medical University, Taichung (C-LL); Graduate Institute of Clinical Medicine Science, School of Medicine (T-MY); Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Leal GN, Silva KF, Lianza AC, Giacomin MF, Andrade JL, Kozu K, Bonfá E, Silva CA. Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study. Scand J Rheumatol 2015; 45:202-9. [DOI: 10.3109/03009742.2015.1063686] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- GN Leal
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - KF Silva
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - AC Lianza
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - MF Giacomin
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
| | - JL Andrade
- Institute of Radiology, Hospital das Clínicas, São Paulo University Medical School
| | - K Kozu
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
| | - E Bonfá
- Department of Rheumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - CA Silva
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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Fernández-Nebro A, Rúa-Figueroa Í, López-Longo FJ, Galindo-Izquierdo M, Calvo-Alén J, Olivé-Marqués A, Ordóñez-Cañizares C, Martín-Martínez MA, Blanco R, Melero-González R, Ibáñez-Rúan J, Bernal-Vidal JA, Tomero-Muriel E, Uriarte-Isacelaya E, Horcada-Rubio L, Freire-González M, Narváez J, Boteanu AL, Santos-Soler G, Andreu JL, Pego-Reigosa JM. Cardiovascular Events in Systemic Lupus Erythematosus: A Nationwide Study in Spain From the RELESSER Registry. Medicine (Baltimore) 2015; 94:e1183. [PMID: 26200625 PMCID: PMC4603000 DOI: 10.1097/md.0000000000001183] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This article estimates the frequency of cardiovascular (CV) events that occurred after diagnosis in a large Spanish cohort of patients with systemic lupus erythematosus (SLE) and investigates the main risk factors for atherosclerosis. RELESSER is a nationwide multicenter, hospital-based registry of SLE patients. This is a cross-sectional study. Demographic and clinical variables, the presence of traditional risk factors, and CV events were collected. A CV event was defined as a myocardial infarction, angina, stroke, and/or peripheral artery disease. Multiple logistic regression analysis was performed to investigate the possible risk factors for atherosclerosis. From 2011 to 2012, 3658 SLE patients were enrolled. Of these, 374 (10.9%) patients suffered at least a CV event. In 269 (7.4%) patients, the CV events occurred after SLE diagnosis (86.2% women, median [interquartile range] age 54.9 years [43.2-66.1], and SLE duration of 212.0 months [120.8-289.0]). Strokes (5.7%) were the most frequent CV event, followed by ischemic heart disease (3.8%) and peripheral artery disease (2.2%). Multivariate analysis identified age (odds ratio [95% confidence interval], 1.03 [1.02-1.04]), hypertension (1.71 [1.20-2.44]), smoking (1.48 [1.06-2.07]), diabetes (2.2 [1.32-3.74]), dyslipidemia (2.18 [1.54-3.09]), neurolupus (2.42 [1.56-3.75]), valvulopathy (2.44 [1.34-4.26]), serositis (1.54 [1.09-2.18]), antiphospholipid antibodies (1.57 [1.13-2.17]), low complement (1.81 [1.12-2.93]), and azathioprine (1.47 [1.04-2.07]) as risk factors for CV events. We have confirmed that SLE patients suffer a high prevalence of premature CV disease. Both traditional and nontraditional risk factors contribute to this higher prevalence. Although it needs to be verified with future studies, our study also shows-for the first time-an association between diabetes and CV events in SLE patients.
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Affiliation(s)
- Antonio Fernández-Nebro
- On behalf of EAS-SER (Systemic Diseases Study Group of the Spanish Society of Rheumatology) From the UGC Reumatología (AFN), Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga; Department of Rheumatology (ÍRF), Dr Negrín General University Hospital, Las Palmas de Gran Canaria, Gran Canaria; Department of Rheumatology (FLL), Gregorio Marañón University Hospital; Department of Rheumatology (MGI), Doce de Octubre University Hospital, Madrid; Department of Rheumatology (JCA), Sierrallana Hospital, Torrelavega; Department of Rheumatology (AOM), Germans Trías i Pujol University Hospital, Badalona; UGC Reumatología (COC), Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga; Research Unit of Spanish Society of Rheumatology (MMM), Madrid; Department of Rheumatology (RB), Marqués de Valdecilla University Hospital, Santander; Department of Rheumatology (RMG), Hospital Complex of Ourense, Ourense; Department of Rheumatology (JIR), POVISA Hospital, Vigo; Department of Rheumatology (JBV), Alicante General University Hospital, Alicante; Department of Rheumatology (ETM), La Princesa University Hospital, Madrid; Department of Rheumatology (EUI), Donosti University Hospital, Guipuzcoa; Department of Rheumatology (LHR), Navarra Hospital, Pamplona; Department of Rheumatology (MFG), Juan Canalejo University Hospital, La Coruña; Department of Rheumatology (JN), Bellvitge University Hospital, Barcelona; Department of Rheumatology (ALB), Ramón y Cajal University Hospital, Madrid; Department of Rheumatology (GSS), Marina Baixa University Hospital, Villajoyosa, Alicante; Department of Rheumatology (JAS), Puerta del Hierro-Majadahonda Hospital, Madrid; and University Hospital Complex (JMPR), Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain
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Koenig KF, Ribi C, Radosavac M, Zulewski H, Trendelenburg M. Prevalence of vascular disease in systemic lupus erythematosus compared with type-1 diabetes mellitus: A cross-sectional study of two cohorts. Lupus 2014; 24:58-65. [DOI: 10.1177/0961203314550223] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Systemic lupus erythematosus (SLE) is associated with considerable cardiovascular morbidity that has not yet been directly compared with other diseases with known cardiovascular risk. Methods Two hundred and forty-one patients of the multicentre Swiss SLE cohort study (SSCS) were cross-sectionally assessed for coronary heart disease (CHD), cerebrovascular disease (CVD) and peripheral artery disease (PAD). SLE patients were compared with a cohort of 193 patients with type-1 diabetes mellitus being followed at the University Hospital Basel. A subgroup analysis of 50 age- and sex-matched patients from the University Hospital Basel was performed. Results Of patients within the SSCS 13.3% had one or more vascular events: 8.3% CHD, 5% CVD and 1.2% PAD. In type-1 diabetes mellitus patients, 15% had vascular events: 9.3% CHD, 3.1% CVD and 5.6% PAD. In the matched subgroup, 26% of SLE patients had vascular events (14% CHD) compared with 12% in type-1 DM patients (2% CHD). Cardiovascular risk factors were similar in both groups. Vascular events in SLE patients were associated with age, longer disease duration, dyslipidaemia, and hypertension. Conclusion Cardiovascular morbidity in SLE is at least as frequent as in age- and sex-matched type-1 diabetes mellitus patients. Therefore, aggressive screening and management of cardiovascular risk factors should be performed.
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Affiliation(s)
- K F Koenig
- Division of Nephrology, University Hospital Basel, Basel, Switzerland
| | - C Ribi
- Division of Immunology and Allergy, CHUV, Lausanne, Switzerland
| | - M Radosavac
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - H Zulewski
- Division of Endocrinology and Diabetology, Triemli Spital, Zürich, Switzerland
| | - M Trendelenburg
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
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Mavrogeni S, Karabela G, Stavropoulos E, Plastiras S, Spiliotis G, Gialafos E, Kolovou G, Sfikakis PP, Kitas GD. Heart failure imaging patterns in systemic lupus erythematosus. Evaluation using cardiovascular magnetic resonance. Int J Cardiol 2014; 176:559-61. [DOI: 10.1016/j.ijcard.2014.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/05/2014] [Indexed: 01/13/2023]
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Abstract
The prevalence of atherosclerosis (ATH) is higher in patients with systemic lupus erythematosus (SLE) and occurs at an earlier age. The lupus-related factors that account for this increased risk are likely numerous and related to the factors described in this article. Identifying of at-risk subjects and increasing the understanding of pathogenesis of ATH in SLE is critical for improving the quality of care and improving mortality in this vulnerable population.
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Affiliation(s)
- Maureen McMahon
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Room 32-59, Los Angeles, CA 90095, USA.
| | - Brian Skaggs
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Room 32-59, Los Angeles, CA 90095, USA
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Amaya-Amaya J, Montoya-Sánchez L, Rojas-Villarraga A. Cardiovascular involvement in autoimmune diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:367359. [PMID: 25177690 PMCID: PMC4142566 DOI: 10.1155/2014/367359] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/01/2014] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases (AD) represent a broad spectrum of chronic conditions that may afflict specific target organs or multiple systems with a significant burden on quality of life. These conditions have common mechanisms including genetic and epigenetics factors, gender disparity, environmental triggers, pathophysiological abnormalities, and certain subphenotypes. Atherosclerosis (AT) was once considered to be a degenerative disease that was an inevitable consequence of aging. However, research in the last three decades has shown that AT is not degenerative or inevitable. It is an autoimmune-inflammatory disease associated with infectious and inflammatory factors characterized by lipoprotein metabolism alteration that leads to immune system activation with the consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation. Both humoral and cellular immune mechanisms have been proposed to participate in the onset and progression of AT. Several risk factors, known as classic risk factors, have been described. Interestingly, the excessive cardiovascular events observed in patients with ADs are not fully explained by these factors. Several novel risk factors contribute to the development of premature vascular damage. In this review, we discuss our current understanding of how traditional and nontraditional risk factors contribute to pathogenesis of CVD in AD.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Laura Montoya-Sánchez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
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Abstract
Rheumatic diseases are associated with an increased risk of cardiovascular (CV) mortality attributed to a higher incidence of heart failure (HF) and ischemic heart disease. Although traditional CV risk factors contribute to the increased incidence seen in this population, by themselves they do not account for the increased risk; in fact, obesity and hyperlipidemia may play a paradoxic role. Immune-mediated mechanisms and chronic inflammation likely play a role in the pathogenesis of CV disease in patients with rheumatic diseases. The usual clinical features of ischemic heart disease and HF are less likely to be seen in this patient population.
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Affiliation(s)
- Kerry Wright
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Garcia MA, Alarcon GS, Boggio G, Hachuel L, Marcos AI, Marcos JC, Gentiletti S, Caeiro F, Sato EI, Borba EF, Brenol JCT, Massardo L, Molina-Restrepo JF, Vasquez G, Guibert-Toledano M, Barile-Fabris L, Amigo MC, Huerta-Yanez GF, Cucho-Venegas JM, Chacon-Diaz R, Pons-Estel BA. Primary cardiac disease in systemic lupus erythematosus patients: protective and risk factors--data from a multi-ethnic Latin American cohort. Rheumatology (Oxford) 2014; 53:1431-8. [DOI: 10.1093/rheumatology/keu011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Huang BT, Yao HM, Huang H. Left Ventricular Remodeling and Dysfunction in Systemic Lupus Erythematosus: A Three-Dimensional Speckle Tracking Study. Echocardiography 2014; 31:1085-94. [PMID: 24446690 DOI: 10.1111/echo.12515] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Bao-Tao Huang
- Department of Cardiology; West China Hospital; Sichuan University; Chengdu China
| | - Hong-Mei Yao
- Department of Cardiology; West China Hospital; Sichuan University; Chengdu China
| | - He Huang
- Department of Cardiology; West China Hospital; Sichuan University; Chengdu China
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61
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Villa-Blanco I, Calvo-Alén J. Utilizing registries in systemic lupus erythematosus clinical research. Expert Rev Clin Immunol 2014; 8:353-60. [DOI: 10.1586/eci.12.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Bose B, Silverman ED, Bargman JM. Ten common mistakes in the management of lupus nephritis. Am J Kidney Dis 2013; 63:667-76. [PMID: 24332767 DOI: 10.1053/j.ajkd.2013.10.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/08/2013] [Indexed: 01/15/2023]
Abstract
Management of patients with lupus nephritis can be complex and challenging. We suggest that there are some widely held misconceptions about lupus, and unfortunately, these underpin the treatment of many patients. There is little evidence to support the common assumption that intravenous pulse cyclophosphamide is the best treatment for lupus nephritis. Although there is much focus on which immunosuppressive agent to use, too little attention is paid to the proper dose and duration of corticosteroids and concomitant therapy with antimalarial agents. Many clinicians reflexively perform kidney biopsies when these biopsies may be high risk and not influence therapy. There is little emphasis on or awareness of nonadherence to therapy, which is an underappreciated cause of treatment resistance. Resolution of proteinuria and hematuria can take a long time, and immunotherapy should not be intensified based on urine sediment alone. Furthermore, the intensity of the immunosuppression must be considered in the context of lupus nephritis class and duration of kidney damage. Finally, clinicians are aware of the risks of pregnancy in the face of active lupus, but assume that their patients also are aware of this and forget to discuss this with them. With a combined experience of more than 50 years in managing children and adults with lupus, we offer our impression of recurrent mistakes in the management of lupus in general, with a focus on treatment of lupus nephritis.
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Affiliation(s)
- Bhadran Bose
- University of Toronto, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Joanne M Bargman
- University of Toronto, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada.
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63
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Othman KMS, Assaf NY. Early detection of premature subclinical coronary atherosclerosis in systemic lupus erythematosus patients. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Gustafsson JT, Svenungsson E. Definitions of and contributions to cardiovascular disease in systemic lupus erythematosus. Autoimmunity 2013; 47:67-76. [PMID: 24228980 DOI: 10.3109/08916934.2013.856005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with systemic lupus erythematosus (SLE) have a significantly increased risk of cardiovascular disease (CVD). Increased prevalence of atherosclerosis may explain part of this enhanced risk, but SLE related CVD can also result from other mechanisms. Vascular events may be the result of several pathophysiologic mechanisms; some can be caused by atherosclerosis, others may be primarily thrombotic, and some may be due to ongoing inflammation. The traditional risk factors are of importance for the development of CVD in lupus. However, lupus-related factors, such as endothelial dysfunction and inflammation, renal impairment and disease activity, lupus phenotype, autoantibodies and genetic predisposition are equally or even more important. Risk factors may also contribute separately or in combination to increase the risk of atherosclerosis and clinical CVD in SLE. Studies investigating risk factors for CVD in SLE vary with respect to definition of outcome, it is, e.g. common that the terms atherosclerosis and clinical CVD are used interchangeably. Varying definitions and outcomes may thus explain divergent results of different studies and make comparisons difficult. This review summarizes some of the current knowledge regarding risk factors and mechanisms for atherosclerosis and clinical CVD in SLE. Aspects on the importance of CVD definitions and outcomes are briefly discussed.
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Affiliation(s)
- Johanna T Gustafsson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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Amaya-Amaya J, Sarmiento-Monroy JC, Caro-Moreno J, Molano-González N, Mantilla RD, Rojas-Villarraga A, Anaya JM. Cardiovascular disease in latin american patients with systemic lupus erythematosus: a cross-sectional study and a systematic review. Autoimmune Dis 2013; 2013:794383. [PMID: 24294522 PMCID: PMC3835818 DOI: 10.1155/2013/794383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/26/2013] [Indexed: 12/24/2022] Open
Abstract
Objective. This study was performed to determine the prevalence of and associated risk factors for cardiovascular disease (CVD) in Latin American (LA) patients with systemic lupus erythematosus (SLE). Methods. First, a cross-sectional analytical study was conducted in 310 Colombian patients with SLE in whom CVD was assessed. Associated factors were examined by multivariate regression analyses. Second, a systematic review of the literature on CVD in SLE in LA was performed. Results. There were 133 (36.5%) Colombian SLE patients with CVD. Dyslipidemia, smoking, coffee consumption, and pleural effusion were positively associated with CVD. An independent effect of coffee consumption and cigarette on CVD was found regardless of gender and duration of disease. In the systematic review, 60 articles fulfilling the eligibility criteria were included. A wide range of CVD prevalence was found (4%-79.5%). Several studies reported ancestry, genetic factors, and polyautoimmunity as novel risk factors for such a condition. Conclusions. A high rate of CVD is observed in LA patients with SLE. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed at facilitating the suppression of cigarette smoking and coffee consumption as well as at the tight control of dyslipidemia and other modifiable risk factors.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences,
Universidad del Rosario, Carrera 24 No. 63C-69, 111221 Bogotá, Colombia
| | - Juan Camilo Sarmiento-Monroy
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences,
Universidad del Rosario, Carrera 24 No. 63C-69, 111221 Bogotá, Colombia
| | - Julián Caro-Moreno
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences,
Universidad del Rosario, Carrera 24 No. 63C-69, 111221 Bogotá, Colombia
| | - Nicolás Molano-González
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences,
Universidad del Rosario, Carrera 24 No. 63C-69, 111221 Bogotá, Colombia
| | - Rubén D. Mantilla
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences,
Universidad del Rosario, Carrera 24 No. 63C-69, 111221 Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences,
Universidad del Rosario, Carrera 24 No. 63C-69, 111221 Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences,
Universidad del Rosario, Carrera 24 No. 63C-69, 111221 Bogotá, Colombia
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The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: A systematic review. Semin Arthritis Rheum 2013; 43:77-95. [DOI: 10.1016/j.semarthrit.2012.12.002] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 11/28/2012] [Accepted: 12/06/2012] [Indexed: 01/09/2023]
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Kandala NB, Connock M, Grove A, Sutcliffe P, Mohiuddin S, Hartley L, Court R, Cummins E, Gordon C, Clarke A. Belimumab: a technological advance for systemic lupus erythematosus patients? Report of a systematic review and meta-analysis. BMJ Open 2013; 3:bmjopen-2013-002852. [PMID: 23872289 PMCID: PMC3717447 DOI: 10.1136/bmjopen-2013-002852] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To undertake a systematic review and meta-analysis to investigate clinical effectiveness of belimumab for patients with systemic lupus erythematosus (SLE) and antinuclear and/or anti-double-stranded DNA (dsDNA) autoantibodies. METHODS We searched eight electronic databases and reference lists for randomised controlled trials (RCTs) of belimumab against placebo or best supportive care. Quality assessment and random effects meta-analysis were undertaken. DESIGN A meta-analysis of RCTs. PARTICIPANTS 2133 SLE patients. PRIMARY AND SECONDARY OUTCOME MEASURES SLE Responder Index (SRI) at week 52. RESULTS Three double-blind placebo-controlled RCTs (L02, BLISS-52 BLISS-76) investigated 2133 SLE patients. BLISS-52 and BLISS-76 trials recruited patients with antinuclear and/or anti-dsDNA autoantibodies and demonstrated belimumab effectiveness for the SRI at week 52. Ethnicity and geographical location of participants varied considerably between BLISS trials. Although tests for statistical heterogeneity were negative, BLISS-52 results were systematically more favourable for all measured outcomes. Meta-analysis of pooled 52-week SRI BLISS results showed benefit for belimumab (OR 1.63, 95% CI 1.27 to 2.09). By week 76, the primary SRI outcome in BLISS-76 was not statistically significant (OR 1.31, 95% CI 0.919 to 1.855).
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Affiliation(s)
- Ngianga-Bakwin Kandala
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- KEMRI-University of Oxford-Wellcome Trust Collaborative Programme, Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Nairobi, Kenya
| | - Martin Connock
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy Grove
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Syed Mohiuddin
- Health Sciences, The University of Manchester, Manchester, UK
| | - Louise Hartley
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ewen Cummins
- McMDC Ltd, McMaster Development Consultants, Glasgow, UK
| | - Caroline Gordon
- School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Ribeiro FM, Fabris CL, Bendet I, Lugon JR. Survival of lupus patients on dialysis: a Brazilian cohort. Rheumatology (Oxford) 2012; 52:494-500. [DOI: 10.1093/rheumatology/kes298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Drenkard C, Dunlop-Thomas C, Easley K, Bao G, Brady T, Lim SS. Benefits of a self-management program in low-income African-American women with systemic lupus erythematosus: results of a pilot test. Lupus 2012; 21:1586-93. [DOI: 10.1177/0961203312458842] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minorities with systemic lupus erythematosus (SLE) are at high risk of poor disease outcomes and may face challenges in effectively self-managing multiple health problems. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based intervention that improves the health of people with chronic illnesses. Although the CDSMP is offered by organizations throughout the United States and many countries around the world, it has not been tested among SLE patients. We pilot tested the benefits of the CDSMP in low-income African American patients with SLE. CDSMP workshops were delivered to 49 African American women with SLE who received medical care at a public lupus clinic in Atlanta, Georgia, US. We compared pre-post CDSMP changes (from baseline to 4 months after the start of the intervention) in health status, self-efficacy and self-management behaviors using self-reported measures. Additionally, we assessed health care utilization changes using electronic administrative records in the 6-month periods before and after the intervention. We observed significant improvements post-intervention in the SF-36 physical health component summary (mean change = 2.4, p = 0.032); self-efficacy (mean change = 0.5, p = 0.035); and several self-management behaviors: cognitive symptoms management (mean change = 0.3, p = 0.036); communication with physicians (mean change = 0.4, p = 0.01); and treatment adherence (mean change = 0.4, p = 0.01). The median number of outpatient visits decreased from 3 to 1 (p < .0001). The CDSMP is a promising intervention for low-income African Americans with SLE. It is an inexpensive program with growing availability around the world that should be further evaluated as a resource to improve patient-centered outcomes and decrease health service utilization among SLE patients.
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Affiliation(s)
- C Drenkard
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - C Dunlop-Thomas
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - K Easley
- Department of Biostatistics and Bioinformatics, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - G Bao
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - T Brady
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - SS Lim
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
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FAURSCHOU MIKKEL, MELLEMKJAER LENE, STARKLINT HENRIK, KAMPER ANNELISE, TARP ULRIK, VOSS ANNE, JACOBSEN SØREN. High Risk of Ischemic Heart Disease in Patients with Lupus Nephritis. J Rheumatol 2011; 38:2400-5. [DOI: 10.3899/jrheum.110329] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the occurrence of ischemic heart disease (IHD) in a cohort of 104 Danish patients with biopsy-proven lupus nephritis (LN).Methods.Information on all hospitalizations in Denmark for IHD between 1977 and 2006 was obtained from the Danish National Hospital Register. Occurrence of IHD after date of first renal biopsy in the LN cohort was compared to the occurrence of IHD in the general population by calculation of standardized ratios of observed to expected events (O:E ratios) for different manifestations of IHD registered during inpatient and outpatient hospital visits.Results.The median duration of followup was 14.7 (range 0.1–30.0) years. Thirty-one first-time hospitalizations for IHD occurred in the cohort, yielding an overall O:E ratio for IHD of 6.8 (95% CI 4.6–9.7). Increased risks were found for angina pectoris (O:E ratio 6.0, 95% CI 3.0–11), myocardial infarction (O:E ratio 7.9, 95% CI 3.8–15), and other IHD-related diagnoses combined (O:E ratio 6.9, 95% CI 3.3–13). A high IHD risk was observed for patients aged < 31 years at time of first renal biopsy (O:E ratio 17.1, 95% CI 9.1–29) and for patients aged 30–39 years during followup (O:E ratio 42.3, 95% CI 21–76). Patients undergoing chronic renal replacement therapy also had a pronounced risk of IHD (O:E ratio 19.4, 95% CI 7.8–40).Conclusion.LN is associated with markedly increased morbidity from IHD. Our findings indicate that patients with early-onset LN have a disturbingly high risk of IHD compared to the general population.
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Plazak W, Pasowicz M, Kostkiewicz M, Podolec J, Tomkiewicz-Pajak L, Musial J, Podolec P. Influence of chronic inflammation and autoimmunity on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients. Inflamm Res 2011; 60:973-80. [PMID: 21744266 PMCID: PMC3171653 DOI: 10.1007/s00011-011-0358-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/23/2011] [Accepted: 06/21/2011] [Indexed: 12/02/2022] Open
Abstract
Objective Conventional risk factors for coronary artery disease fail to explain the increased frequency or cardiovascular morbidity in systemic lupus erythematosus (SLE) patients. This study was conducted to determine the possible influence of autoimmune and inflammatory phenomena markers on coronary artery calcifications and myocardial perfusion abnormalities in SLE patients. Materials and methods Multi-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emission computerized tomography (SPECT) studies (Tc-99m sestamibi) were performed in 60 SLE patients in stable clinical condition, without a prior history of coronary artery disease. Laboratory evaluation included serum C-reactive protein (CRP), complement C3c and C4 components and antiphospholipid antibodies (aPL). The latter included anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies, of both IgG and IgM classes, and lupus anticoagulant (LA) in plasma. Results SPECT revealed persistent perfusion defects in 22 (36.7%) patients and exercise-induced defects in eight (13.3%), while MDCT revealed coronary calcifications in 15 (25%). Calcium scores ranged from 1 to 843.2 (mean 113.5 ± 259.7). No association was found between conventional coronary artery disease risk factors (obesity, hypertension, tobacco use, hyperlipidaemia, diabetes) nor CRP, C3c or C4 levels and coronary calcifications or myocardial perfusion defects. On the contrary, in patients with these pathologies, augmented autoimmunization was found, reflected by increased aCL IgG and antiβ2GPI IgG levels. In patients with aCL IgG >20 RU/ml or antiβ2GPI IgG >3 RU/ml, the relative risk of coronary calcification formation was 4.1 compared to patients with normal values. Accordingly, in LA-positive patients the relative risk of coronary calcification formation was 4.4 compared to LA-negative patients. Conclusions Conventional risk factors for coronary artery disease as well as markers of an ongoing inflammation did not show any association with perfusion defects and/or coronary artery calcifications in SLE patients. On the contrary, calcified atherosclerotic plaques and myocardial perfusion defects were observed mainly in patients with elevated levels of anticardiolipin and aβ2GPI antibodies of the IgG class. It might be speculated that coronary artery calcifications and perfusion defects are a result of antiphospholipid antibodies-induced coronary artery microthrombosis.
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Affiliation(s)
- Wojciech Plazak
- Department of Cardiac and Vascular Diseases, The John Paul II Hospital, Jagiellonian University Medical College, ul. Pradnicka 80, 31-202 Krakow, Poland.
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Plazak W, Gryga K, Milewski M, Podolec M, Kostkiewicz M, Podolec P, Musial J. Association of heart structure and function abnormalities with laboratory findings in patients with systemic lupus erythematosus. Lupus 2011; 20:936-44. [DOI: 10.1177/0961203311399607] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conventional risk factors of coronary artery disease fail to explain the increased frequency of cardiovascular morbidity in patients with systemic lupus erythematosus (SLE). The study was conducted to determine possible association between the heart structure and function abnormalities with established prognostic value assessed by non-invasive imaging techniques and markers of autoimmune and inflammatory phenomena typical for SLE. Echocardiography and single photon emission computerized tomography (SPECT; Tc-99m-MIBI) at rest were performed in 60 SLE patients in a stable clinical condition of their disease. Laboratory evaluation included serum levels of C-reactive protein (CRP), complement C3c and C4 components and antiphospholipid antibodies (aPL). The latter included serum anticardiolipin (aCL) and anti-β2-glycoprotein I (antiβ2GPI) antibodies, both of IgG and IgM class, and lupus anticoagulant (LA) in plasma. Echocardiography revealed pathologic thickening of valvular leaflets and/or pericardium in more than 60% of patients. Right ventricular systolic pressure (RVSP) was elevated (>30 mmHg) in 16.7%. Myocardial perfusion defects were present in 36.7% of patients, despite normal ECG recordings and a lack of clinical symptoms of myocardial ischaemia. There was a significant association between thickening of valvular leaflets and/or pericardium and high CRP and low C3c and C4 concentrations. On the other hand, increased RVSP and the presence of myocardial perfusion defects were associated with the presence of anticardiolipin and antiβ2GPI antibodies of the IgG class. Increased anticardiolipin IgG levels predicted perfusion defects in SPECT study with 100% sensitivity and 68% specificity, whereas elevated antiβ2GPI IgG levels predicted RVSP elevation (>30 mmHg) with 100% sensitivity and 78% specificity. In stable SLE patients pericardial and valve abnormalities may be associated with markers of an ongoing inflammation. Also, pulmonary systolic pressure elevation and myocardial perfusion defects are combined with elevated levels of anticardiolipin and antiβ2GPI antibodies of the IgG class. These results indicate that even clinically silent pulmonary hypertension and myocardial perfusion defects in SLE patients could be causally related to the presence of antiphospholipid antibodies.
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Affiliation(s)
- W Plazak
- Department of Cardiac and Vascular Diseases, The John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - K Gryga
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - M Milewski
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - M Podolec
- Department of Coronary Heart Disease, The John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - M Kostkiewicz
- Department of Cardiac and Vascular Diseases, The John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - P Podolec
- Department of Cardiac and Vascular Diseases, The John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - J Musial
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
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Plazak W, Gryga K, Dziedzic H, Tomkiewicz-Pajak L, Konieczynska M, Podolec P, Musial J. Influence of atorvastatin on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients: a prospective, randomized, double-masked, placebo-controlled study. Arthritis Res Ther 2011; 13:R117. [PMID: 21774822 PMCID: PMC3239355 DOI: 10.1186/ar3402] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 05/09/2011] [Accepted: 07/20/2011] [Indexed: 01/08/2023] Open
Abstract
Introduction Mortality in systemic lupus erythematosus (SLE) patients is influenced by an increased occurrence of severe cardiovascular complications. Statins have been proven to protect a wide spectrum of SLE patients from these complications. This study was conducted to determine the possible efficacy of atorvastatin in SLE patients as assessed by multi-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emission computed tomography (SPECT) of the myocardium. Methods Sixty SLE patients in stable clinical conditions were randomized to receive either atorvastatin (40 mg daily; n = 28) or placebo (n = 32). Clinical and biochemical evaluation together with MDCT-based coronary calcium scoring and SPECT studies (Tc-99 m sestamibi) were performed at the time of randomization and after 1 year of treatment. Results At randomization, SPECT revealed perfusion defects at rest in 22 (36.7%) patients and exercise-induced defects in 8 (13.3%), whereas MDCT revealed coronary calcifications in 15 subjects (25%). Coronary calcium deposits increased after 1 year in the placebo group (plaque volume change from 35.2 ± 44.9 to 62.9 ± 72.4, P < 0.05; calcium score from 32.1 ± 39.1 to 59.5 ± 64.4; P < 0.05), but not in the atorvastatin group (plaque volume 54.5 ± 62.4 vs. 51.0 ± 47.6, P not significant; calcium score 44.8 ± 50.6 vs. 54.9 ± 62.5, P not significant). The atorvastatin group showed a decrease in total serum cholesterol (from 5.1 ± 1.2 to 4.4 ± 0.7 mmol/L, P < 0.05), LDL cholesterol (2.9 ± 1.0 to 2.3 ± 0.6 mmol/L, P < 0.05), triglycerides (1.6 ± 0.6 to 1.2 ± 0.5 mmol/L, P < 0.05), and C-reactive protein (CRP) (4.4 ± 4.1 to 2.7 ± 1.7 mg/L, P < 0.05). There was no change in the mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score in patients from both groups. Perfusion defects observed at randomization showed no change after one year treatment with atorvastatin. Conclusions In SLE patients 40 mg of atorvastatin daily for 1 year led to a decrease in serum lipids and CRP levels. Additionally the progression of atherosclerosis, as assessed by MDCT-based coronary calcium scoring, is restrained by atorvastatin treatment. The value of statin treatment in patients with SLE free from cardiovascular disease clinical symptoms should be addressed in large, prospective clinical trials.
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Abstract
Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease with a highly variable clinical course. Pediatric-onset SLE (pSLE) represents 10-20% of all SLE cases, and is associated with higher disease severity, including more-rapid damage accrual, than adult-onset SLE. As in adults, pSLE disease expression varies according to ethnicity, with a milder disease course in white patients. The majority of pSLE patients will have developed damage within 5-10 years of disease onset, most frequently involving the musculoskeletal, ocular, renal and neuropsychiatric systems. Owing to improvements in disease management and recognition over the past 20-30 years, patients now live longer, but as a result have increased disease damage. Premature atherosclerosis and osteoporosis have become increasingly prevalent morbidities in pSLE patients. Early atherosclerosis leads to a considerable rise in cardiovascular and cerebrovascular events, and failure to develop adequate peak bone mass during adolescence-a crucial period of bone accrual-is likely to lead to early osteoporosis and fractures. Patients with pSLE have an incurable, potentially devastating disease that occurs during a vulnerable period of psychosocial development, leading to specific and unique psychosocial stressors. Additional large, long-term follow-up studies in pSLE are needed to better understand the disease prognosis and to facilitate development of tailored treatments.
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disorder, with a heterogeneous presentation. Disease severity is wide ranging, with most suffering milder forms; however, it is potentially fatal depending on organ involvement. The disorder was recognized as early as the Middle Ages, with the 12th-century physician Rogerius being the first to apply the term lupus to the classic malar rash, and in 1872, Moric Kaposi first recognized the systemic nature of the disease. Perioperatively, SLE can present major challenges to the anesthesiologist because of accrued organ damage, coagulation defects, and complex management regimes. In this article I highlight adult SLE manifestations and treatments pertinent to the anesthesiologist and discuss perioperative management of these complex patients.
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Pérez-De-Lis M, Akasbi M, Sisó A, Diez-Cascon P, Brito-Zerón P, Diaz-Lagares C, Ortiz J, Perez-Alvarez R, Ramos-Casals M, Coca A. Cardiovascular risk factors in primary Sjögren's syndrome: a case-control study in 624 patients. Lupus 2010; 19:941-8. [DOI: 10.1177/0961203310367504] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the prevalence and clinical significance of cardiovascular risk factors in a large series of patients with primary Sjögren’s syndrome (SS), focusing on the possible association with clinical and immunological SS features, the therapies administered, and the impact on cardiovascular disease. The study cohort included 312 patients fulfilling the 2002 classification criteria for primary SS, consecutively evaluated and followed in our department between 1984 and 2009. The control group consisted of 312 age- and sex-matched patients without systemic autoimmune diseases followed during the study period in a primary care centre. In comparison with the age- and sex-matched control group, patients with primary SS showed a higher frequency of diabetes mellitus (27% versus 13%, p < 0.001) and hypertriglyceridaemia (22% versus 15%, p = 0.023), and a lower frequency of hypertension (30% versus 46%, p < 0.001) and smoking (19% versus 31%, p < 0.001). The adjusted, multivariate analysis showed that SS patients with at least three cardiovascular risk factors had a higher mean age at SS diagnosis (p < 0.001), a higher frequency of liver involvement (p = 0.01) and central nervous system involvement (p = 0.001), higher mean levels of C-reactive protein (CRP, p = 0.001), a lower percentage of circulating gamma globulins (p = 0.001), and had received corticosteroids more frequently (p = 0.003) in comparison with patients without cardiovascular risk factors. Patients who had received corticosteroids showed a higher frequency of hypertension (37% versus 25%, p = 0.032), diabetes mellitus (37% versus 21%, p = 0.002), and hypertriglyceridaemia (33% versus 15%, p < 0.001). Patients with primary SS showed a twofold higher prevalence of diabetes mellitus and a 1.5-fold higher prevalence of hypertriglyceridaemia in comparison with primary care patients. Corticosteroid use was closely associated with cardiovascular risk factors. These results suggest that cardiovascular risk factors should be taken into account in the management of patients with primary SS and show the importance of recognizing and controlling both traditional and SS-related modifiable risk factors.
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Affiliation(s)
- M. Pérez-De-Lis
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Department of Autoimmune Diseases, Barcelona, Spain
| | - M. Akasbi
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Department of Autoimmune Diseases, Barcelona, Spain
| | - A. Sisó
- Primary Care Research Group, Institut d'Investigacìons Biomèdiques August Pi i Sunyer, Centre d'Assistència Primària ABS Les Corts, GESCLINIC, Barcelona, Spain
| | - P. Diez-Cascon
- Primary Care Research Group, Institut d'Investigacìons Biomèdiques August Pi i Sunyer, Centre d'Assistència Primària ABS Les Corts, GESCLINIC, Barcelona, Spain
| | - P. Brito-Zerón
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Department of Autoimmune Diseases, Barcelona, Spain
| | - C. Diaz-Lagares
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Department of Autoimmune Diseases, Barcelona, Spain
| | - J. Ortiz
- Primary Care Research Group, Institut d'Investigacìons Biomèdiques August Pi i Sunyer, Centre d'Assistència Primària ABS Les Corts, GESCLINIC, Barcelona, Spain
| | - R. Perez-Alvarez
- Department of Internal Medicine, Hospital do Meixoeiro, Vigo, Spain
| | - M. Ramos-Casals
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Department of Autoimmune Diseases, Barcelona, Spain,
| | - A. Coca
- Hypertension Unit, Department of Internal Medicine, ICMiD, Hospital Clínic, Barcelona, Spain
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Skamra C, Ramsey-Goldman R. Management of cardiovascular complications in systemic lupus erythematosus. ACTA ACUST UNITED AC 2010; 5:75-100. [PMID: 20305727 DOI: 10.2217/ijr.09.73] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients with SLE have an excess risk compared with the general population; this is particularly pronounced in younger women with SLE who have an excess risk of over 50-fold compared with population controls. There is a higher prevalence of subclinical atherosclerosis in patients with SLE compared with controls, as demonstrated by a variety of imaging modalities discussed in this review. The causality of the excess risk of CVD and subclinical atherosclerosis is multifactorial in patients with SLE. While traditional risk factors play a role, after controlling for the traditional Framingham risk factors, the excess risk is still 7.5-fold greater than the general population. This review will also cover novel cardiovascular risk factors and some SLE-specific variables that contribute to CVD risk. This review discusses the risk factor modification and the evidence available for treatment of these risk factors in SLE. There have not yet been any published randomized, controlled trials in patients with SLE with respect to CVD risk factor modifications. Thus, the treatment and management recommendations are based largely on published guidelines for other populations at high risk for CVD.
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Parker B, Bruce IN. The Metabolic Syndrome in Systemic Lupus Erythematosus. Rheum Dis Clin North Am 2010; 36:81-97, viii. [DOI: 10.1016/j.rdc.2009.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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