Factors associated with coronary artery calcification in young female patients with SLE.
BACKGROUND
With improved survival rates of patients with systemic lupus erythematosus (SLE), damage such as accelerated atherosclerosis gains increasing importance.


OBJECTIVE
To identify the prevalence of coronary artery calcifications (CAC) in asymptomatic patients.


METHODS
Electron beam tomography (EBT) was performed in 75 female patients with SLE aged <50. The results were correlated with traditional and SLE related factors associated with CAC. 49 women with symptomatic coronary heart disease (CHD) and 279 women without CHD were also analysed.


RESULTS
Overall, 21/75 (28%) patients had CAC. Low HDL cholesterol levels <1.40 mmol/l (p=0.03, OR=1.8, 67% v 39%) and cigarette smoking (p=0.01, OR=5.7, 76% v 44%) were identified as factors associated with CAC. Hypertension and high cholesterol were more common in women with CHD (p<0.01) than in those without CHD. SLE related factors were proteinuria (1331 v 465 mg/day, p=0.02), impaired renal function (p=0.02, OR=2.6, 26% v 6%), and high C3 levels (p=0.04, OR=1.8, 65% v 38%). High C3 levels were also more common in symptomatic CHD (p=0.02). The prevalence of Sm antibodies was lower in patients with CAC (15% v 42%, p=0.03). In a multivariate analysis, cigarette smoking, reduced renal function, high C3, and a cumulative steroid dose above 30 g were the most important CAC associated factors in the lupus cohort.


CONCLUSIONS
A subgroup of patients with SLE with CAC without any clinical symptoms of CHD was identified by EBT. Therefore, EBT is useful for assessing asymptomatic atherosclerosis in this group.
Manger
K
K
Department of Internal Medicine III and Institute for Clinical Immunology, University Erlangen-Nuremberg, Germany. Department of Internal Medicine II, University Erlangen-Nuremberg, Germany. karin.manger@med.imed.uni-erlangen.de
Kusus
M
M
Forster
C
C
Ropers
D
D
Daniel
W G
WG
Kalden
J R
JR
Achenbach
S
S
Manger
B
B
D000328:Adult; D000367:Age Factors; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D011507:Proteinuria / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed