title: Assessment of coronary risk based on cumulative exposure to lipids in systemic lupus erythematosus.
abstract: OBJECTIVE
  To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE).
  
  
  METHODS
  Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient. Time-dependent proportional hazards regression models were used to quantify the risk of coronary event [myocardial infarction (MI) or angina], after adjustment for age.
  
  
  RESULTS
  Among 384 patients, over a mean (SD) followup of 3.81 (2.58) years, there were 21 "first" coronary events (6 MI, 15 angina). Mean and TAM LDL-C (HR 1.83, 95% CI 1.19-2.81, p = 0.006), TC:HDL ratio (HR 1.43, 95% CI 1.02-2.00, p = 0.04), and TG (HR 2.11, 95% CI 1.32-3.39, p = 0.0019) were predictive of coronary event at subsequent visits. In contingency table analysis, TAM LDL-C cutpoint of 2.0 mmol/l had a sensitivity and negative predictive value for coronary event of 85.7% (95% CI 63.7-97.0) and 93.9% (95% CI 83.1-98.7), respectively. However, at this cutpoint the specificity was only 12.7% (95% CI 9.4-16.5).
  
  
  CONCLUSIONS
  This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.
authors.affiliation: From the University of Toronto Lupus Clinic and the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada; The University of Melbourne Departments of Medicine and Rheumatology, St. Vincent's Hospital, Melbourne, Victoria, Australia; Division of Cardiology, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Mandana
authors.initials: M
authors.lastname: Nikpour
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
authors.forename: Dominique
authors.initials: D
authors.lastname: Ibanez
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Harvey
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000453:epidemiology / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000378:metabolism*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000097:blood*; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000378:metabolism; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014280:Triglycerides / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008055:Lipids; D014280:Triglycerides
keywords: CORONARY ARTERY DISEASE; LIPIDS; LIPOPROTEINS; RISK FACTORS; SYSTEMIC LUPUS ERYTHEMATOSUS