Advertisement
Mayo Clinic Proceedings Home
MCP Digital Health Home

Systemic Lupus Erythematosus and Increased Prevalence of Atherosclerotic Cardiovascular Disease in Hospitalized Patients

      Abstract

      Objective

      To assess the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its individual phenotypes of coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease by age and sex in a large US cohort of hospitalized patients with systemic lupus erythematosus (SLE).

      Methods

      A nested case-control study of adults with and without SLE was conducted from the January 1, 2008, through December 31, 2014, National Inpatient Sample. Hospitalized patients with SLE were matched (1:3) by age, sex, race, and calendar year to hospitalized patients without SLE. The prevalences of CAD, PAD, and cerebrovascular disease were evaluated, and associations with SLE were determined after adjustment for common cardiovascular risk factors.

      Results

      Among the 252,676 patients with SLE and 758,034 matched patients without SLE, the mean age was 51 years, 89% were women, and 49% were white. Patients with SLE had a higher prevalence of ASCVD vs those without SLE (25.6% vs 19.2%; OR, 1.45; 95% CI, 1.44-1.47; P<.001). After multivariable adjustment, SLE was associated with a greater odds of ASCVD (adjusted odds ratio [aOR], 1.46; 95% CI, 1.41-1.51). The association between SLE and ASCVD was observed in women and men and was attenuated with increasing age. Also, SLE was associated with increased odds of CAD (aOR, 1.42; 95% CI, 1.40-1.44), PAD (aOR, 1.25; 95% CI, 1.22-1.28), and cerebrovascular disease (aOR, 1.68; 95% CI, 1.65-1.71).

      Conclusion

      In hospitalized US patients, SLE was associated with increased ASCVD prevalence, which was observed in both sexes and was greatest in younger patients.

      Abbreviations and Acronyms:

      aOR (adjusted odds ratio), ASCVD (atherosclerotic cardiovascular disease), CAD (coronary artery disease), CKD (chronic kidney disease), ICD-9 (International Classification of Diseases, Ninth Revision), NIS (National Inpatient Sample), OR (odds ratio), PAD (peripheral artery disease), SLE (systemic lupus erythematosus)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pons-Estel G.J.
        • Alarcón G.S.
        • Scofield L.
        • Reinlib L.
        • Cooper G.S.
        Understanding the epidemiology and progression of systemic lupus erythematosus.
        Semin Arthritis Rheum. 2010; 39: 257-268
        • Tsokos G.C.
        Systemic lupus erythematosus.
        N Engl J Med. 2011; 365: 2110-2121
        • Izmirly P.M.
        • Wan I.
        • Sahl S.
        • et al.
        The incidence and prevalence of systemic lupus erythematosus in New York County (Manhattan), New York: the Manhattan Lupus Surveillance Program.
        Arthritis Rheumatol. 2017; 69: 2006-2017
        • Ward M.M.
        Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythematosus.
        Arthritis Rheum. 1999; 42: 338-346
        • Manzi S.
        • Meilahn E.N.
        • Rairie J.E.
        • et al.
        Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study.
        Am J Epidemiol. 1997; 145: 408-415
        • Hansson G.K.
        Immune mechanisms in atherosclerosis.
        Arterioscler Thromb Vasc Biol. 2001; 21: 1876-1890
        • Rho Y.H.
        • Chung C.P.
        • Oeser A.
        • et al.
        Novel cardiovascular risk factors in premature coronary atherosclerosis associated with systemic lupus erythematosus.
        J Rheumatol. 2008; 35: 1789-1794
        • Joseph J.E.
        • Harrison P.
        • Mackie I.J.
        • Isenberg D.A.
        • Machin S.J.
        Increased circulating platelet-leucocyte complexes and platelet activation in patients with antiphospholipid syndrome, systemic lupus erythematosus and rheumatoid arthritis.
        Br J Haematol. 2001; 115: 451-459
        • Nhek S.
        • Clancy R.
        • Lee K.A.
        • et al.
        Activated platelets induce endothelial cell activation via an interleukin-1β pathway in systemic lupus erythematosus.
        Arterioscler Thromb Vasc Biol. 2017; 37: 707-716
        • Gurtner G.H.
        • Burke-Wolin T.
        Interactions of oxidant stress and vascular reactivity.
        Am J Physiol. 1991; 260: L207-L211
        • Nuttall S.L.
        • Heaton S.
        • Piper M.K.
        • Martin U.
        • Gordon C.
        Cardiovascular risk in systemic lupus erythematosus: evidence of increased oxidative stress and dyslipidaemia.
        Rheumatology. 2003; 42: 758-762
        • Bruce I.N.
        • Clark-Soloninka C.A.
        • Spitzer K.A.
        • Gladman D.D.
        • Urowitz M.B.
        • Laskin C.A.
        Prevalence of antibodies to beta2-glycoprotein I in systemic lupus erythematosus and their association with antiphospholipid antibody syndrome criteria: a single center study and literature review.
        J Rheumatol. 2000; 27: 2833-2837
        • El-Magadmi M.
        • Bodill H.
        • Ahmad Y.
        • et al.
        Systemic lupus erythematosus: an independent risk factor for endothelial dysfunction in women.
        Circulation. 2004; 110: 399-404
        • Johnson S.
        • Harvey P.
        • Floras J.
        • et al.
        Impaired brachial artery endothelium dependent flow mediated dilation in systemic lupus erythematosus: preliminary observations.
        Lupus. 2004; 13: 590-593
        • Gustafsson J.
        • Gunnarsson I.
        • Börjesson O.
        • et al.
        Predictors of the first cardiovascular event in patients with systemic lupus erythematosus: a prospective cohort study.
        Arthritis Res Ther. 2009; 11: R186
        • Borba E.F.
        • Santos R.D.
        • Bonfa E.
        • et al.
        Lipoprotein(a) levels in systemic lupus erythematosus.
        J Rheumatol. 1994; 21: 220-223
        • Nicholls S.J.
        • Zheng L.
        • Hazen S.L.
        Formation of dysfunctional high-density lipoprotein by myeloperoxidase.
        Trends Cardiovasc Med. 2005; 15: 212-219
        • Bengtsson C.
        • Ohman M.-L.
        • Nived O.
        • Rantapää Dahlqvist S.
        Cardiovascular event in systemic lupus erythematosus in northern Sweden: incidence and predictors in a 7-year follow-up study.
        Lupus. 2012; 21: 452-459
        • Hak A.E.
        • Karlson E.W.
        • Feskanich D.
        • Stampfer M.J.
        • Costenbader K.H.
        Systemic lupus erythematosus and the risk of cardiovascular disease: results from the Nurses’ Health Study.
        Arthritis Rheum. 2009; 61: 1396-1402
        • Urowitz M.B.
        • Gladman D.D.
        • Anderson N.M.
        • et al.
        Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort.
        Lupus Sci Med. 2016; 3: e000143
        • Mok C.C.
        • Ho L.Y.
        • To C.H.
        Annual incidence and standardized incidence ratio of cerebrovascular accidents in patients with systemic lupus erythematosus.
        Scand J Rheumatol. 2009; 38: 362-368
        • Roman M.J.
        • Shanker B.-A.
        • Davis A.
        • et al.
        Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus.
        N Engl J Med. 2003; 349: 2399-2406
        • Asanuma Y.
        • Oeser A.
        • Shintani A.K.
        • et al.
        Premature coronary-artery atherosclerosis in systemic lupus erythematosus.
        N Engl J Med. 2003; 349: 2407-2415
        • Rubin L.A.
        • Urowitz M.B.
        • Gladman D.D.
        Mortality in systemic lupus erythematosus: the bimodal pattern revisited.
        Q J Med. 1985; 55: 87-98
        • Steiner C.
        • Elixhauser A.
        • Schnaier J.
        The healthcare cost and utilization project: an overview.
        Eff Clin Pract. 2002; 5: 143-151
        • Knight A.M.
        • Weiss P.F.
        • Morales K.H.
        • Keren R.
        National trends in pediatric systemic lupus erythematosus hospitalization in the United States: 2000-2009.
        J Rheumatol. 2014; 41: 539-546
        • Bulkley B.H.
        • Roberts W.C.
        The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: a study of 36 necropsy patients.
        Am J Med. 1975; 58: 243-264
        • Esdaile J.M.
        • Abrahamowicz M.
        • Grodzicky T.
        • et al.
        Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus.
        Arthritis Rheum. 2001; 44: 2331-2337
        • Ugarte-Gil M.F.
        • Alarcón G.S.
        Incomplete systemic lupus erythematosus: early diagnosis or overdiagnosis?.
        Arthritis Care Res (Hoboken). 2016; 68: 285-287

      Linked Article

      • In the Limelight: August 2019
        Mayo Clinic ProceedingsVol. 94Issue 8
        • Preview
          This monthly feature highlights four articles in the current print and online issue of Mayo Clinic Proceedings. These articles are also featured on the Mayo Clinic Proceedings' YouTube Channel ( https://youtu.be/FQUoKRbu5ps ).
        • Full-Text
        • PDF