Risk factors for coronary heart disease in women with systemic lupus erythematosus -: The Toronto Risk Factor Study
Risk factors for coronary heart disease in women with systemic lupus erythematosus -: The Toronto Risk Factor Study
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DOI：
10.1002/art.11296
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发表时间：
2003-11-01
影响因子：
--
通讯作者：
Steiner, G
中科院分区：
文献类型：
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作者：
Bruce, IN;Urowitz, MB;Steiner, G
目标。由于患有系统性红斑狼疮(SLE)的女性患冠心病(CHD)的可能性是普通女性的5-8倍，因此我们评估了SLE女性患冠心病的经典危险因素的患病率。研究对象是在多伦多一家大型狼疮诊所就诊的无冠心病证据的连续女性SLE患者。对照人群是从参加家庭实践单位年度体检的年龄匹配的受试者中招募的。使用Framingham风险评估公式确定典型CHD风险因素的流行率和CHD相关事件的10年风险。两组间的血脂亚组分、其他代谢危险因素、生活方式变量和人口学特征也进行了比较。我们研究了250名SLE患者和250名对照组，他们的平均+/-SD年龄分别为44.8+/-12岁和44.3+/-15岁。高血压和糖尿病在SLE患者中明显更常见。尽管SLE患者平均每个患者有更多的CHD风险因素，但根据Framingham多风险因素评估，SLE患者和对照组发生CHD相关事件的10年风险是相同的(3.2%)。与对照组相比，SLE患者的极低密度脂蛋白胆固醇和总甘油三酯水平更高，尽管叶酸水平更高，但同型半胱氨酸水平更高。在SLE患者中，过早绝经、久坐不动的生活方式和危险的身体习惯也更为普遍。患有系统性红斑狼疮的女性有一系列可检测到的冠状动脉风险因素，这些因素在弗雷明翰风险因素公式中没有完全反映出来。这些因素很可能导致系统性红斑狼疮患者失去对CHD的保护。
Objective. Because women with systemic lupus erythematosus (SLE) are 5-8 times more likely to develop coronary heart disease (CHD) than are women in the general population, we assessed the prevalence of classic risk factors for CHD in women with SLE.Methods. Consecutive female patients with SLE who were without evidence of CHD and were attending a large lupus clinic in Toronto were studied. The control population was recruited from among age-matched subjects attending a family practice unit for an annual physical examination. The prevalence of classic CHD risk factors and the 10-year risk of a CHD-related event were determined using the Framingham risk assessment formula. Lipid subfractions, other metabolic risk factors, lifestyle variables, and demographic characteristics were also compared between the 2 groups.Results. We studied 250 SLE patients and 250 controls whose mean +/- SD age was 44.8 +/- 12 years and 44.3 +/- 15 years, respectively. Hypertension and diabetes were significantly more common among the SLE patients. Although the SLE patients had a higher mean number of CHD risk factors per patient, the 10-year risk of a CHD-related event, using the Framingham multiple risk factor assessment, was the same in SLE patients and controls (3.2%). Compared with controls, SLE patients had higher levels of very low-density lipoprotein cholesterol and total triglycerides, and had higher levels of homocysteine despite having higher folate levels. Premature menopause, sedentary lifestyle, and an at-risk body habitus were also more prevalent in SLE patients.Conclusion. Women with SLE have a range of detectable coronary risk factors that are not fully reflected in the Framingham risk factor formula. These factors are likely to contribute to the loss of protection from CHD that has been observed in SLE.