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Risk Factors in the Progression of Subclinical Atherosclerosis in Women With Systemic Lupus Erythematosus
Author(s) -
Lertratanakul Apinya,
Wu Peggy,
Dyer Alan R.,
Kondos George,
Edmundowicz Daniel,
Carr James,
RamseyGoldman Rosalind
Publication year - 2014
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22271
Subject(s) - medicine , odds ratio , population , confidence interval , rheumatology , cohort , gastroenterology , cardiology , environmental health
Objective To investigate risk factors in subclinical atherosclerosis progression as measured by coronary artery calcium (CAC) and aorta calcium (AC) in women with systemic lupus erythematosus (SLE; cases) and in comparison with a control population. Methods A cohort of 149 cases and 124 controls participated in the Study of Lupus Vascular and Bone Long‐Term Endpoints. Demographic information, cardiovascular and SLE risk factors, and laboratory assessments were collected at an initial visit. CAC and AC were measured by electron beam computed tomography (CT) or multidetector CT at an initial visit and at a followup visit. Logistic regression models were used to identify predictors of progression in CAC and AC; multivariate models were adjusted for age, hypertension, and total cholesterol to high‐density lipoprotein ratio. Results Higher modified Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score (odds ratio [OR] 2.15, 95% confidence interval [95% CI] 1.33–3.57), use of a corticosteroid (OR 2.93, 95% CI 1.14–7.86), and use of aspirin (OR 4.23, 95% CI 1.53–11.74) were associated with CAC progression in multivariate models. Presence of SLE (OR 2.64, 95% CI 1.26–5.72), lower C3 (OR 0.54, 95% CI 0.33–0.87), lower C4 (OR 0.49, 95% CI 0.27–0.86), use of a corticosteroid (OR 2.73, 95% CI 1.03–7.64), higher corticosteroid dose (OR 1.77, 95% CI 1.12–3.00), higher lipoprotein(a) (OR 1.80, 95% CI 1.11–2.98), and higher homocysteine (OR 2.06, 95% CI 1.06–4.29) were associated with AC progression in multivariate models. Conclusion Higher disease damage at the first study visit, as measured by the modified SDI, may predict increased risk in CAC progression, whereas higher disease activity at the first study visit, as measured by hypocomplementemia and use of corticosteroids, may predict increased risk in AC progression.