title: Cardiovascular disease and cognitive dysfunction in systemic lupus erythematosus.
abstract: OBJECTIVE
  Cognitive dysfunction and cardiovascular disease are common and debilitating manifestations of systemic lupus erythematosus (SLE). In this study, we evaluated the relationship between cardiovascular events, traditional cardiovascular risk factors, and SLE-specific risk factors as predictors of cognitive dysfunction in a large cohort of participants with SLE.
  
  
  METHODS
  Subjects included 694 participants from the Lupus Outcomes Study (LOS), a longitudinal study of SLE outcomes based on an annual telephone survey querying demographic and clinical variables. The Hopkins Verbal Learning Test-Revised and the Controlled Oral Word Association Test were administered to assess cognitive function. Multiple logistic regression was used to identify cardiovascular events (myocardial infarction, stroke), traditional cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking), and SLE-specific risk factors (antiphospholipid antibodies [aPL], disease activity, disease duration) associated with cognitive impairment in year 7 of the LOS.
  
  
  RESULTS
  The prevalence of cognitive impairment as measured by verbal memory and verbal fluency metrics was 15%. In adjusted multiple logistic regression analyses, aPL (odds ratio [OR] 2.10, 95% confidence interval [95% CI] 1.3-3.41), hypertension (OR 2.06, 95% CI 1.19-3.56), and a history of stroke (OR 2.27, 95% CI 1.16-4.43) were significantly associated with cognitive dysfunction. In additional analyses evaluating the association between these predictors and severity of cognitive impairment, stroke was significantly more prevalent in participants with severe impairment when compared to those with mild or moderate impairment (P = 0.036).
  
  
  CONCLUSIONS
  These results suggest that the presence of aPL, hypertension, and stroke are key variables associated with cognitive impairment, which may aid in identification of patients at greatest risk.
authors.affiliation: University of California, San Francisco, 94143-0320, USA. sara.murray@ucsf.edu
authors.forename: Sara G
authors.initials: SG
authors.lastname: Murray
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Rachel
authors.initials: R
authors.lastname: Kaiser
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Criswell
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yelin
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Julian
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008568:Memory; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology
chemical_list: D017152:Antibodies, Antiphospholipid