title: Incidence and risk analysis of aortic aneurysm and aortic dissection among patients with systemic lupus erythematosus: a nationwide population-based study in Taiwan.
abstract: OBJECTIVE
  The objective of our study was to determine the incidence rates and risk factors of aortic aneurysm and aortic dissection among patients with systemic lupus erythematosus (SLE) using a nationwide population-based data set.
  
  
  METHODS
  We conducted a retrospective cohort study using data from the Taiwan National Health Insurance database. Patients with SLE and age-, sex- and comorbidity-matched control patients without SLE were identified. The primary endpoint was the first occurrence of aortic aneurysm or aortic dissection. The incidence rate ratios (IRRs) were calculated based on a 95% confidence interval (CI). A Cox proportional-hazards model was used to evaluate the risk factors for aortic aneurysm and aortic dissection in the SLE cohort.
  
  
  RESULTS
  Among the 15,209 patients with SLE (89.9% women and mean age of 38.3 years), 20 developed aortic aneurysm and 13 developed aortic dissection (overall incidence rate, 4.26 per 10,000 person-years). Compared with the control patients, the overall IRR for developing aortic aneurysm or aortic dissection was 3.34 (95% CI, 1.71-6.91; p < 0.001). The IRRs for aortic aneurysm or aortic dissection were 2.98 (95% CI, 1.41-6.70, p = 0.018) for women and 5.50 (95% CI, 1.10-53.15, p = 0.020) for men. Multivariate Cox regression analysis showed that age, male sex, an SLE diagnosis greater than three years prior and hypertension were associated with aortic aneurysm and aortic dissection.
  
  
  CONCLUSIONS
  Aortic aneurysm and aortic dissection occur at higher rates in SLE patients than in people without SLE and a longer disease duration is associated with a higher risk of these rare vascular complications.
authors.affiliation: Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Medical University Shuang Ho Hospital, Taiwan National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: S-H
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Medical University Shuang Ho Hospital, Taiwan National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Chang
authors.affiliation: National Yang-Ming University, School of Medicine, Taipei, Taiwan Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taiwan.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Liu
authors.affiliation: National Yang-Ming University, School of Medicine, Taipei, Taiwan Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lai
authors.affiliation: National Yang-Ming University, School of Medicine, Taipei, Taiwan Department of Family Medicine, Taipei Veterans General Hospital, Taiwan.
authors.forename: T-J
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: National Yang-Ming University, School of Medicine, Taipei, Taiwan Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan wschen2@vghtpe.gov.tw.
authors.forename: W-S
authors.initials: WS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000453:epidemiology* / Q000209:etiology*; D001014:Aortic Aneurysm / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology
keywords: Systemic lupus erythematosus; accelerated atherosclerosis; aortic aneurysm; aortic dissection