Systemic lupus erythematosus risk factors for coronary artery calcifications.
OBJECTIVE
Premature atherosclerosis in patients with SLE is partially explained by traditional risk factors; therefore, we aimed to identify lupus-related risk factors for coronary artery calcifications.


METHODS
An inception cohort of 139 lupus patients (93% females) was screened for coronary artery calcifications using Multidetector CT, after 5.1 years of follow-up. Clinical and immunological variables and cardiovascular risk factors were assessed longitudinally. Also, 100 age- and sex-matched healthy subjects were studied. Correlates for calcifications were analysed in lupus patients, including levels of lipids and inflammatory molecules in samples obtained at enrolment, mid-term follow-up and at screening.


RESULTS
At enrolment, lupus patients were 27.2 (9.1) years of age and with a disease duration of 5.4 (3.8) months. Calcifications were detected in 7.2% of patients and 1% of controls [unadjusted odds ratio (OR) 7.7, 95% CI 1.05, 336.3, P = 0.02]. In lupus, calcifications were detected since the age of 23 years and from 3 years of diagnosis. Patients with calcifications were older, post-menopausal, and had higher levels of serum apolipoprotein B and Framingham risk scores (P < 0.05). Lupus-related factors identified included age at diagnosis, IgG aCLs, cumulative lupus activity, length of moderate/severe activity and cumulative dose of prednisone and CYC (P < 0.05). Use of anti-malarials was protective (P = 0.006). Logistic regression analysis showed as predictors of calcification: disease duration (OR 15.1, 95% CI 2.6, 87.2), age at enrolment (OR 8.5, 95% CI 1.7, 43.0) and SLEDAI 2000 update (SLEDAI-2K) mean area under the curve (OR 12.3, 95% CI 2.5, 61.8). Longitudinal analyses of lipids and inflammatory molecules did not differ between patients.


CONCLUSIONS
Disease activity is a potentially modifiable risk factor for coronary artery calcifications in SLE. Therefore, management of traditional risk factors plus tight control of lupus activity, including the use of anti-malarials, is recommended.
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 México, D.F. México.
Juanita
J
Romero-Díaz
Florencia
F
Vargas-Vóracková
Erick
E
Kimura-Hayama
Luis F
LF
Cortázar-Benítez
Rubén
R
Gijón-Mitre
Sergio
S
Criales
Javier
J
Cabiedes-Contreras
María Del Rocío
Mdel R
Iñiguez-Rodríguez
Eunice Alejandra
EA
Lara-García
Carlos
C
Núñez-Alvarez
Luis
L
Llorente
Carlos
C
Aguilar-Salinas
Jorge
J
Sánchez-Guerrero
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008055:Lipids / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D018836:Inflammation Mediators; D008055:Lipids