Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort.
OBJECTIVE
To describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up.


METHODS
The systemic lupus international collaborating clinics (SLICC) atherosclerosis inception cohort enters patients within 15 months of SLE diagnosis. MIs were reported and attributed on a specialised vascular event form. MIs were confirmed by one or more of the following: abnormal ECG, typical or atypical symptoms with ECG abnormalities and elevated enzymes (≥2 times upper limit of normal), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used.


RESULTS
31 of 1848 patients who entered the cohort had an MI. Of those, 23 patients had an MI prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied, 60.9% were female, 78.3% were Caucasian, 8.7% black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5±15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1±7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up. Risk factors associated with early MI in univariate analysis are male sex, Caucasian, older age at diagnosis, hypertension, hypercholesterolaemia, family history of MI and smoking. In multivariate analysis only age (OR=1.06 95% CI 1.03 to 1.09), hypertension (OR=5.01, 95% CI 1.38 to 18.23), hypercholesterolaemia (OR=4.43, 95% CI 1.51 to 12.99) and smoking (OR=7.50, 95% CI 2.38 to 23.57) remained significant risk factors.


CONCLUSIONS
In some patients with lupus, MI may develop even before the diagnosis of SLE or shortly thereafter, suggesting that there may be a link between autoimmune inflammation and atherosclerosis.
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.
M B
MB
Urowitz
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.
D D
DD
Gladman
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.
N M
NM
Anderson
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.
J
J
Su
Instituto Nacional de Ciencias Medicas y Nutrición , Mexico City , Mexico.
J
J
Romero-Diaz
Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Korea.
S C
SC
Bae
Division of Rheumatology , Centre Hospitalier Universitaire de Québec et Université Laval , Quebec City , Canada.
P R
PR
Fortin
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada.
J
J
Sanchez-Guerrero
Division of Rheumatology , Cumming School of Medicine University of Calgary , Calgary, Alberta , Canada.
A
A
Clarke
Divisions of Clinical Immunology/Allergy and Clinical Epidemiology , Montreal General Hospital, McGill University Health Centre , Montreal, Quebec , Canada.
S
S
Bernatsky
Rheumatology Research Group , School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK.
C
C
Gordon
Division of Rheumatology, Department of Medicine and Department of Pathology , Queen Elizabeth II Health Sciences Centre and Dalhousie University , Halifax, Nova Scotia , Canada.
J G
JG
Hanly
Cedars-Sinai/David Geffen School of Medicine at UCLA , Los Angeles, California , USA.
D J
DJ
Wallace
Centre for Rheumatology Research, University College , London , UK.
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D
Isenberg
Centre for Rheumatology Research, University College , London , UK.
A
A
Rahman
Department of Clinical Pharmacology , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA.
J
J
Merrill
Department of Medicine , SUNY Downstate Medical Center , Brooklyn, New York , USA.
E
E
Ginzler
Department of Medicine, Division of Clinical Immunology and Rheumatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
G S
GS
Alarcón
Department of Medicine, Division of Clinical Immunology and Rheumatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
B F
BF
Fessler
Department of Rheumatology , Johns Hopkins University School of Medicine , Baltimore, Maryland , USA.
M
M
Petri
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, London, UK.
I N
IN
Bruce
Lupus Research Unit , The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine , London , UK.
M
M
Khamashta
Feinstein Institute for Medical Research , Manhasset, New York , USA.
C
C
Aranow
Division of Rheumatology and Immunology, Department of Medicine , University of North Carolina , Chapel Hill, North Carolina , USA.
M
M
Dooley
Department of Medicine , West Penn Allegheny , Pittsburgh, Pennsylvania , USA.
S
S
Manzi
Northwestern University and Feinberg School of Medicine , Chicago, Illinois , USA.
R
R
Ramsey-Goldman
Department of Rheumatology , University Hospital Lund , Lund , Sweden.
G
G
Sturfelt
Department of Rheumatology , University Hospital Lund , Lund , Sweden.
O
O
Nived
Department of Rheumatology , Center for Rheumatology Research Fossvogur Landspitali University Hospital , Reyjkavik , Iceland.
K
K
Steinsson
Lanarkshire Centre for Rheumatology, Hairmyres Hospital , East Kilbride, Scotland , UK.
A
A
Zoma
Autoimmune Disease Unit, Department of Internal Medicine , Hospital Universitario Cruces., University of the Basque Country , Barakaldo , Spain.
G
G
Ruiz-Irastorza
Division of Rheumatology, Emory University School of Medicine , Atlanta, Georgia , USA.
S
S
Lim
UCSD School of Medicine , La Jolla, California , USA.
K C
KC
Kalunian
Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey.
M
M
Ỉnanç
Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute , Stockholm , Sweden.
R
R
van Vollenhoven
Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases , Hospital Clínic , Barcelona , Spain.
M
M
Ramos-Casals
Division of Rheumatology, Medical University of South Carolina , Charleston, South Carolina , USA.
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DL
Kamen
Department of Rheumatology Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark.
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S
Jacobsen
Department of Medicine and Community Health Sciences, University of Manitoba , Winnipeg, Manitoba , Canada.
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C
Peschken
Division of Rheumatology, Columbia University Medical Center , New York , USA.
A
A
Askanase
Department of Rheumatology , Kantousspital , Schaffhausen , Switzerland.
T
T
Stoll
Cardiovascular Disease; Inflammation; Systemic Lupus Erythematosus