title: The association between systemic lupus erythematosus and valvular heart disease: an extensive data analysis.
abstract: BACKGROUND
  Association between antiphospholipid syndrome in systemic lupus erythematosus (SLE) and valvular heart disease (VHD) is well reported, but relatively few studies have been carried out to establish the linkage between VHD and SLE itself. We aimed to investigate link between VHD and SLE and to evaluate the association of diverse factors with VHD among these patients in a large-scale population-based study.
  
  
  METHODS
  We used the databases of the largest state-mandated health service organization in Israel. All SLE patients were included (n = 5018) as well as their age and sex-matched controls (n = 25 090), creating a cross-sectional population-based study. Medical records of all subjects were analysed for documented VHD and the presence of antiphospholipid antibodies (aPLs). A logistic regression model was carried out to evaluate the diverse factors including SLE and aPLs as independent risk factors for VHD.
  
  
  RESULTS
  Valvular heart disease were found to be more frequent among SLE group when compared to controls (aortic stenosis, 1·08% vs. 0·35% respectively, P < 0·001; aortic insufficiency, 1·32% vs. 0·29% respectively, P < 0·001; mitral stenosis, 0·74% vs. 0·21% respectively, P < 0·001; mitral insufficiency, 1·91% vs. 0·39% respectively, P < 0·001). Male sex, hypertension, aPLs and SLE were found to be significant independent risk factors for VHD.
  
  
  CONCLUSIONS
  All VHD are more prevalent among SLE patients when compared to controls. SLE and aPLs are independent risk factor for VHD (OR of 2·46 and 1·7, respectively). Physicians must be aware of such significant association, and routine echocardiography should be considered in SLE patients regardless of their aPL status.
authors.affiliation: Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.|Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Abdulla
authors.initials: A
authors.lastname: Watad
authors.affiliation: Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Shmuel
authors.identifier: http://orcid.org/0000-0002-1748-4297
authors.initials: S
authors.lastname: Tiosano
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Noam
authors.initials: N
authors.lastname: Grysman
authors.affiliation: Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Comaneshter
authors.affiliation: Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel.|Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Arnon D
authors.initials: AD
authors.lastname: Cohen
authors.affiliation: Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.affiliation: Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.|Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Howard
authors.identifier: http://orcid.org/0000-0002-5406-7716
authors.initials: H
authors.lastname: Amital
mesh_terms: D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000453:epidemiology* / Q000276:immunology; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000276:immunology; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000276:immunology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000276:immunology; D008946:Mitral Valve Stenosis / Q000453:epidemiology / Q000276:immunology; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D017152:Antibodies, Antiphospholipid
keywords: Antiphospholipids antibodies; Libman-Sacks; lupus; mitral insufficiency; systemic lupus erythematosus; valve heart disease