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Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort
Author(s) -
Urowitz Murray B.,
Gladman Dafna D.,
Farewell Ver,
Su Jiandong,
Romero-Diaz Juanita,
Bae Sang-Cheol,
Fortin Paul R.,
SanchezGuerrero Jorge,
Clarke Ann Elaine,
Bernatsky Sasha,
Gordon Caroline,
Hanly John G.,
Wallace Daniel J.,
Isenberg David A.,
Rahman Anisur,
Merrill Joan T.,
Ginzler Ellen,
Alarcón Graciela S.,
Chatham W. Winn,
Petri Michelle A.,
Bruce Ian N.,
Khamashta Munther A.,
Aranow Cynthia,
Dooley Mary Anne,
Manzi Susan,
RamseyGoldman Rosalind,
Nived Ola,
Jönsen Andreas,
Steinsson Kristján,
Zoma Asad A.,
Ruiz-Irastorza Guillermo,
Lim S. Sam,
Kalunian Kenneth C.,
Ỉnanç Murat,
Vollenhoven Ronald,
RamosCasals Manuel,
Kamen Diane L.,
Jacobsen Soren,
Peschken Christine A.,
Askanase Anca,
Stoll Thomas
Publication year - 2020
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41392
Subject(s) - medicine , hazard ratio , cohort , confidence interval , cohort study , rate ratio , systemic lupus erythematosus , proportional hazards model , disease
Objective In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods A large 33‐center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient‐years, and univariable and multivariable relative risk regression models. Results Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow‐up visit after enrollment, for a total of 13,666 patient‐years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient‐years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32–0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55–10.30]) and a body mass index of >40 kg/m 2 (HR 2.74 [95% CI 1.04–7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17–9.27], P < 0.001). Conclusion The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.