title: Mortality and cardiovascular burden of systemic lupus erythematosus in a US population-based cohort.
abstract: OBJECTIVE
  To examine the mortality and cardiovascular disease (CVD) burden among a population-based cohort of patients with systemic lupus erythematosus (SLE) with previously described late mean onset and low rates of organ-threatening disease.
  
  
  METHODS
  This retrospective population-based cohort study investigated incident cases of SLE diagnosed from 1991-2008 and followed through March 2009 to examine rates of death and CVD events: myocardial infarction, stroke, or congestive heart failure hospitalization. Cases were identified using the 1997 update of the 1982 American College of Rheumatology SLE criteria. Searches included electronic records, chart audits, and state death matches, with physician review. Age-matched and sex-matched population comparisons facilitated relative event rate calculations.
  
  
  RESULTS
  Seventy incident SLE cases had late mean onset (52 years), with an incidence of 5 cases per 100,000/year. Matched comparisons showed similar baseline rates of hypertension, hyperlipidemia, and diabetes. However, patients with SLE experienced more CVD in the 2 years preceding SLE diagnosis (OR 3.8, 95% CI 1.8, 8.0). The estimated 10-year mortality rates were 26% for SLE subjects versus 19% for comparisons, hazard ratio (HR) 2.1, p<0.01. Adjusted for prior CVD, SLE cases still demonstrated increased hazards of mortality (HR 1.9, p=0.01) and CVD event or death (HR 1.8, p=0.01).
  
  
  CONCLUSIONS
  This incident SLE cohort demonstrated nearly doubled mortality and CVD event hazards compared to age-matched and sex-matched comparisons, even after accounting for higher CVD events in the 2 years preceding SLE diagnosis. This raises research questions regarding delayed SLE diagnosis versus accelerated CVD prior to SLE, particularly in older-onset SLE.
authors.affiliation: From the Department of Medicine, Rheumatology Section, and Department of Biostatistics, University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Wisconsin; Division of Rheumatology, Marshfield Clinic, and Epidemiology Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin; Division of Internal Medicine-Pediatrics, Health East Woodbury Clinic, Woodbury, Minnesota; Division of Internal Medicine, Springfield Clinic, Springfield, Illinois, USA.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Buhr
authors.forename: Jerry W
authors.initials: JW
authors.lastname: Goldberg
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Bell
authors.forename: Maja
authors.initials: M
authors.lastname: Visekruna
authors.forename: Swapna
authors.initials: S
authors.lastname: Nekkanti
authors.forename: Robert T
authors.initials: RT
authors.lastname: Greenlee
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis
keywords: CARDIOVASCULAR SYSTEM; COHORT STUDY; EPIDEMIOLOGY; INCIDENCE; MORTALITY; SYSTEMIC LUPUS ERYTHEMATOSUS