Incidence of and Risk Factors for Adverse Cardiovascular Events Among Patients With Systemic Lupus Erythematosus
Incidence of and Risk Factors for Adverse Cardiovascular Events Among Patients With Systemic Lupus Erythematosus
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DOI：
10.1093/aje/kws130
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发表时间：
2012-10-15
影响因子：
5
通讯作者：
Petri, Michelle
中科院分区：
文献类型：
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作者：
Magder, Laurence S.;Petri, Michelle
系统性红斑狼疮(SLE)患者发生心血管事件(CVE)的风险过高。在这种增加的风险中，SLE疾病活动、药物或传统风险因素的相对重要性存在不确定性。为了深入了解这一点，作者使用合并Logistic回归分析方法分析了一组1,874名SLE患者的数据，这些患者每季度在一个临床中心(1987年4月至2010年6月)就诊。在9485人年的随访中，作者观察到134例CVE(14.1/1000人年)。这是基于弗雷明翰风险评分的普通人群预期的2.66倍(95可信区间：2.16，3.16)。调整年龄后，CVE发生率与SLE病程无关。然而，它们与过去SLE疾病活动的平均水平和最近循环中的反双链DNA水平有关。过去使用皮质类固醇类药物(在没有目前使用的情况下)与CVE发生率无关。然而，目前每天使用20毫克或更多皮质类固醇的人，即使在对疾病活动进行调整后，风险也会大幅增加。因此，与最近在患有其他疾病的队列中发表的几篇论文中的研究结果一致，目前使用皮质类固醇与心血管疾病风险增加有关。这些结果表明，皮质类固醇对CVE风险有短期影响。
Patients with systemic lupus erythematosus (SLE) are at excess risk of cardiovascular events (CVEs). There is uncertainty regarding the relative importance of SLE disease activity, medications, or traditional risk factors in this increased risk. To gain insight into this, the authors analyzed data from a cohort of 1,874 patients with SLE who were seen quarterly at a single clinical center (April 1987June 2010) using pooled logistic regression analysis. In 9,485 person-years of follow-up, the authors observed 134 CVEs (rate 14.1/1,000 person-years). This was 2.66 times what would be expected in the general population based on Framingham risk scores (95 confidence interval: 2.16, 3.16). After adjustment for age, CVE rates were not associated with duration of SLE. However, they were associated with average past levels of SLE disease activity and recent levels of circulating anti-double-stranded DNA. Past use of corticosteroids (in the absence of current use) was not associated with CVE rates. However, persons currently using 20 mg/day or more of corticosteroids had a substantial increase in risk even after adjustment for disease activity. Thus, consistent with findings in several recent publications among cohorts with other diseases, current use of corticosteroids was associated with an increased risk of CVEs. These results suggest a short-term impact of corticosteroids on CVE risk.