Coronary calcium in systemic lupus erythematosus is associated with traditional cardiovascular risk factors, but not with disease activity.
OBJECTIVE
Cardiovascular disease is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). The frequency of both subclinical and clinically evident atherosclerosis is greatly increased over healthy controls. We assessed cardiovascular risk factors present in patients with SLE at the baseline visit in a statin intervention trial and their correlation with coronary calcium.


METHODS
Coronary calcium was measured by helical computed tomography (continuous volumetric data acquisition in a single breath-hold) in 200 patients with SLE enrolled in the Lupus Atherosclerosis Prevention Study.


RESULTS
Patients had a mean age of 44.3 +/- 11.4 years and were 92% women, 61% Caucasian, 34% African American, 2% Asian, and 2% Hispanic. Coronary calcium was found in 43%. In univariate analysis, coronary calcification was associated with age (p = 0.0001), hypertension (p = 0.0008), body mass index (BMI; p = 0.03), erythrocyte sedimentation rate (ESR; p = 0.03), anti-dsDNA (p = 0.067), and lipoprotein(a) (p = 0.03). Homocysteine (p = 0.050), high-sensitivity C-reactive protein (hsCRP; p = 0.053), and LDL (p = 0.048) had a stronger association when considered as quantitative predictors. In a multiple logistic regression model, only age (p </= 0.0001) and body mass index (p = 0.0014) remained independent predictors. No measure of SLE activity was associated with coronary calcium. We also examined variables independently predictive of a coronary calcium score > 100. Based on a multiple logistic regression model, only age (p = 0.0017) and diabetes mellitus (p = 0.019) remained significant independent predictors of coronary calcium > 100.


CONCLUSIONS
Inflammation, measured as ESR or hsCRP, is associated with coronary calcium only in univariate analyses. Age, BMI, and diabetes mellitus are more important associates of coronary calcium in SLE than inflammatory markers and SLE clinical activity.
Kiani
Adnan N
AN
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Magder
Laurence
L
Petri
Michelle
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis; D048909:Diabetes Complications; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D036542:Tomography, Spiral Computed
D017270:Lipoprotein(a); D006710:Homocysteine