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Factors Associated with Arterial Vascular Events in PROFILE: A Multiethnic Lupus Cohort

Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA

LM Vilá

Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USAlvila{at}rcm.upr.edu

GS Alarcón

Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

G McGwin

Section of Trauma, Burns, and Critical Care, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

JC Edberg

Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

M Petri

Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA

R Ramsey-Goldman

Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

JD Reveille

Division of Rheumatology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA

RP Kimberly

Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

for the PROFILE Study Group

The objective of this study was to determine the factors associated with the occurrence of arterial vascular events in a multiethnic systemic lupus erythematosus (SLE) cohort. The PROFILE cohort, comprised SLE patients (n = 1333) of defined ethnicity from five different US institutions, was studied to determine demographic, clinical and biological variables associated with vascular events. An arterial vascular event (first episode) was either a myocardial infarction, angina pectoris and/or a vascular procedure for myocardial infarction, stroke, claudication and/or evidence of gangrene. Patient characteristics were analyzed by univariable and multivariable Cox proportional hazards regression analyses. One-hundred twenty-three (9.8%) patients had at least one incident arterial event. Age at cohort enrollment (HR = 1.04, 95% CI 1.03–1.06), smoking (HR = 2.20, 95% CI 1.40–3.46) and the CRP2* C alleles (HR = 1.91, 95% CI 1.04–3.49) were associated with a shorter time-to-the occurrence of arterial vascular events. Some clinical manifestations of disease activity were associated with a shorter time-to-occurrence [psychosis (HR = 2.21, 95% CI 1.10–4.44), seizures (HR = 1.85, 95% CI 1.00–3.24) and anaemia (HR = 1.83, 95% CI 1.02–3.31)], but others were not [arthritis (HR = 0.32, 95% CI 0.18–0.58)]. In conclusion, older patients, especially in the context of a predisposing environmental factor (smoking) and severe clinical manifestations, are at higher risk of having arterial vascular events. The genetic contribution of the variation at the CRP locus was not obscured by demographic or clinical variables. Awareness of these factors should lead to more effective management strategies of patients at risk for arterial vascular events.

Key Words: cardiovascular disease • systemic lupus erythematosus • thrombosis

Lupus, Vol. 18, No. 11, 958-965 (2009)
DOI: 10.1177/0961203309104862


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