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Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events.
Arthritis Rheum 2004; 50(12):3947-57AR

Abstract

OBJECTIVE

To determine the baseline (time 0) risk factors associated with the subsequent occurrence of vascular events in a multiethnic US cohort (LUMINA [LUpus in MInorities: NAture versus nurture]) of patients with systemic lupus erythematosus (SLE).

METHODS

Five hundred forty-six LUMINA patients were assessed at time 0 for traditional and nontraditional (disease-related) risk factors for vascular events. These were defined as 1) cardiovascular (myocardial infarction and/or definite or classic angina and/or the undergoing of a vascular procedure for myocardial infarction [coronary artery bypass graft]), 2) cerebrovascular (stroke), and 3) peripheral vascular (arterial claudication and/or gangrene or significant tissue loss and/or arterial thrombosis in peripheral arteries). The observation time (followup time in the cohort) was the interval between time 0 and the last visit. The unit of analysis was the patient and not each vascular event. Variables at time 0 and vascular events were examined by univariable and multivariable (logistic and Cox proportional hazards regression) analyses. Age, sex, ethnicity, followup time, and all known risk factors for the occurrence of vascular events were included in the model.

RESULTS

Thirty-four patients (6.2%) developed one or more vascular event after time 0. The overall median duration of followup in the cohort was 73.8 months (range 10.8-111.3 months). Vascular events (13 cardiovascular, 18 cerebrovascular, 5 peripheral vascular) occurred in 7 Hispanics from Texas (6.5%), 1 Hispanic from Puerto Rico (1.2%), 15 African Americans (7.5%), and 11 Caucasians (7.1%). The mean total number of traditional risk factors was significantly higher in patients who developed vascular events than in those who did not (7.1 versus 5.6). Independent predictors of vascular events were older age, current smoking status, longer followup time, elevated serum levels of C-reactive protein (CRP), and the presence of any antiphospholipid antibody. The same variables were identified when time-dependent analyses were performed, although azathioprine use was also found to be a contributing factor.

CONCLUSION

Smoking, previously not reported in SLE, emerged as a predictor of vascular events and should be strongly discouraged. Antiphospholipid antibodies and CRP support the role of inflammation and autoimmunity in the development of accelerated atherosclerosis in SLE. Ethnicity was not associated with vascular events in our patients.

Authors+Show Affiliations

School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15593203

Citation

Toloza, Sergio M A., et al. "Systemic Lupus Erythematosus in a Multiethnic US Cohort (LUMINA). XXIII. Baseline Predictors of Vascular Events." Arthritis and Rheumatism, vol. 50, no. 12, 2004, pp. 3947-57.
Toloza SM, Uribe AG, McGwin G, et al. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. Arthritis Rheum. 2004;50(12):3947-57.
Toloza, S. M., Uribe, A. G., McGwin, G., Alarcón, G. S., Fessler, B. J., Bastian, H. M., ... Reveille, J. D. (2004). Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. Arthritis and Rheumatism, 50(12), pp. 3947-57.
Toloza SM, et al. Systemic Lupus Erythematosus in a Multiethnic US Cohort (LUMINA). XXIII. Baseline Predictors of Vascular Events. Arthritis Rheum. 2004;50(12):3947-57. PubMed PMID: 15593203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. AU - Toloza,Sergio M A, AU - Uribe,América G, AU - McGwin,Gerald,Jr AU - Alarcón,Graciela S, AU - Fessler,Barri J, AU - Bastian,Holly M, AU - Vilá,Luis M, AU - Wu,Ruihua, AU - Shoenfeld,Yehuda, AU - Roseman,Jeffrey M, AU - Reveille,John D, AU - ,, PY - 2004/12/14/pubmed PY - 2005/1/14/medline PY - 2004/12/14/entrez SP - 3947 EP - 57 JF - Arthritis and rheumatism JO - Arthritis Rheum. VL - 50 IS - 12 N2 - OBJECTIVE: To determine the baseline (time 0) risk factors associated with the subsequent occurrence of vascular events in a multiethnic US cohort (LUMINA [LUpus in MInorities: NAture versus nurture]) of patients with systemic lupus erythematosus (SLE). METHODS: Five hundred forty-six LUMINA patients were assessed at time 0 for traditional and nontraditional (disease-related) risk factors for vascular events. These were defined as 1) cardiovascular (myocardial infarction and/or definite or classic angina and/or the undergoing of a vascular procedure for myocardial infarction [coronary artery bypass graft]), 2) cerebrovascular (stroke), and 3) peripheral vascular (arterial claudication and/or gangrene or significant tissue loss and/or arterial thrombosis in peripheral arteries). The observation time (followup time in the cohort) was the interval between time 0 and the last visit. The unit of analysis was the patient and not each vascular event. Variables at time 0 and vascular events were examined by univariable and multivariable (logistic and Cox proportional hazards regression) analyses. Age, sex, ethnicity, followup time, and all known risk factors for the occurrence of vascular events were included in the model. RESULTS: Thirty-four patients (6.2%) developed one or more vascular event after time 0. The overall median duration of followup in the cohort was 73.8 months (range 10.8-111.3 months). Vascular events (13 cardiovascular, 18 cerebrovascular, 5 peripheral vascular) occurred in 7 Hispanics from Texas (6.5%), 1 Hispanic from Puerto Rico (1.2%), 15 African Americans (7.5%), and 11 Caucasians (7.1%). The mean total number of traditional risk factors was significantly higher in patients who developed vascular events than in those who did not (7.1 versus 5.6). Independent predictors of vascular events were older age, current smoking status, longer followup time, elevated serum levels of C-reactive protein (CRP), and the presence of any antiphospholipid antibody. The same variables were identified when time-dependent analyses were performed, although azathioprine use was also found to be a contributing factor. CONCLUSION: Smoking, previously not reported in SLE, emerged as a predictor of vascular events and should be strongly discouraged. Antiphospholipid antibodies and CRP support the role of inflammation and autoimmunity in the development of accelerated atherosclerosis in SLE. Ethnicity was not associated with vascular events in our patients. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/15593203/Systemic_lupus_erythematosus_in_a_multiethnic_US_cohort__LUMINA___XXIII__Baseline_predictors_of_vascular_events_ L2 - https://doi.org/10.1002/art.20622 DB - PRIME DP - Unbound Medicine ER -