Abstract P166: Cardiovascular Disease Burden Among In-patients With Systemic Lupus Erythematosus

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Laura P Kimble ◽  
Sandra B Dunbar ◽  
Elizabeth J Corwin ◽  
Rebecca Mitchell ◽  
Ignacio Sanz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Renal Failure ◽  
African American ◽  
Cardiovascular Risk ◽  
Supraventricular Tachycardia ◽  
Lupus Erythematosus ◽  
Disease Burden ◽  
Systemic Lupus

Introduction: Systemic lupus erythematosus (SLE) disproportionately affects minority women of childbearing age and is associated with increased cardiovascular risk. Understanding concomitant cardiovascular co-morbidities in the SLE population is essential to reduce their excess cardiovascular burden through targeted risk reduction. Purpose: This study examined cardiovascular co-morbidities in persons with SLE admitted to an acute care hospital. Method: We conducted a secondary data analysis of de-identified electronic health record (EHR) data from a random sample of 1,000,000 patients who received care from a healthcare system in the southeastern US between the years of 2012 and 2018. We targeted the specific patient encounter of the first hospitalization in which SLE was included as a discharge diagnosis and examined cardiovascular co-morbidities present in the cohort. Results: We identified 320 patients (89% women n=285/320, 84.4% n=270/320 African-American) with a mean age of 47.1 ± 16.4 years and length of stay (LOS) of 6.7 ± 8.1 days. The majority were hospitalized on an emergent basis (61%, n=195/320) with 44.4% (n=143/320) admitted to hospital medicine/internal medicine specialties. Admission to cardiology/cardiovascular surgery specialties was noted for 7.5% (n=27/320). The majority were discharged to home for self-care (70.9%, n=227/320) or home health services (12.5%, n=40/320). Potential SLE complications were evident with 23.7% (n=76/320) noted to have renal failure. The most common cardiovascular diagnoses documented in the EHR included: hypertension (40%, n=192/320), heart failure (18.4%, n=59/320), coronary artery disease (16.6%, n=50/320), mitral valve disorders (9.7%,n=31/320), atrial fibrillation (8.7%, n=27/320), supraventricular tachycardia (6.6%,n=21/320), acute myocardial infarction (6.2%,n=20/320), cerebral vascular accident (5.9%, n=19/320), endocarditis (4.1%,n=13/320), and peripheral vascular disease (3.7%, n=12/320). Longer LOS was associated with renal failure (r= .25, p = .001), heart failure (r= .20, p = .001), and supraventricular tachycardia (r=.22, p = .001). A greater proportion of men had endocarditis (14.3%, n=5/35), PVD (11.4%,n = 4/35), and CAD (28.6%, n=10/35) compared to women (endocarditis: 2.8%, n=8/285, p =.008; PVD 2.8%, n=8/285, p= .032; CAD 14.0% n=40/285, p=.044). Conclusion: Cardiovascular disease burden was evident in this predominantly young, female, African-American SLE inpatients. Cardiac diagnoses were associated with increased LOS and men with SLE had greater cardiovascular burden related to CAD and PVD compared to women. These findings highlight the importance of cardiovascular risk reduction interventions and aggressive management of cardiovascular comorbidities in the SLE population.

scholarly journals Dose-dependent oral glucocorticoid cardiovascular risk in people with immune-mediated inflammatory diseases

2020 ◽  
Author(s):  
Mar Pujades-Rodriguez ◽  
Ann W Morgan ◽  
Richard M Cubbon ◽  
Jianhua Wu
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systemic Lupus Erythematosus ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Systemic Lupus ◽  
Immune Mediated ◽  
Dose Dependent

ABSTRACTBackgroundEvidence for the association between glucocorticoid dose and cardiovascular risk is weak for moderate and low doses. To quantify glucocorticoid dose-dependent cardiovascular risk in people with six immune-mediated inflammatory diseases.Methods and FindingsPopulation-based cohort analysis of medical records from 389 primary care practices contributing data to the UK Clinical Practice Research Datalink, linked to hospital admissions and deaths in 1998-2017. There were 87,794 patients with giant cell arteritis and/or polymyalgia rheumatica (n=25,581), inflammatory bowel disease (n=27,739), rheumatoid arthritis (n=25,324), systemic lupus erythematosus (n=3951), and/or vasculitis (n=5199); and no prior cardiovascular disease (CVD). Mean age was 56 years and 34.1% were men. Median follow-up time was 5.0 years. Time-variant daily and cumulative glucocorticoid prednisolone-equivalent dose-related risks and hazard ratios of first all-cause and type-specific CVD.We found 13,426 (15.3%) people with incident CVD, including 6,013 atrial fibrillation, 7,727 heart failure and 2,809 acute myocardial infarction events. At 1 and 5 years, the cumulative risks of all-cause CVD increased from 1.5% in periods of non-use to 9.1% for a daily prednisolone-equivalent dose of ≥25.0mg, and from 7.6% to 29.9%, respectively. We found strong dose-dependent estimates for all immune-mediated diseases (hazard ratio [HR] for <5.0mg daily dose vs. non-use=1.74, 95%CI 1.64-1.84; range 1.52 for polymyalgia rheumatica and/or giant cell arteritis to 2.82 for systemic lupus erythematosus), all cardiovascular outcomes, regardless of disease activity level. The highest estimates were for heart failure and acute myocardial infarction.ConclusionsWe estimated glucocorticoid dose-dependent cardiovascular risk in six immune-mediated diseases. Results highlight the importance of prompt and regular monitoring of cardiovascular risk and use of primary prevention treatment at all glucocorticoid doses.

scholarly journals Anti-dsDNA Antibodies Increase the Cardiovascular Risk in Systemic Lupus Erythematosus Promoting a Distinctive Immune and Vascular Activation

2021 ◽  
Author(s):  
Alejandra María Patiño-Trives ◽  
Carlos Pérez-Sánchez ◽  
Laura Pérez-Sánchez ◽  
María Luque-Tévar ◽  
M. Carmen Ábalos-Aguilera ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Protein Expression ◽  
Lupus Erythematosus ◽  
Expression Profiles ◽  
Molecular Profile ◽  
Systemic Lupus ◽  
Gene And Protein Expression ◽  
Dsdna Antibodies

Objective: Systemic lupus erythematosus (SLE) is associated to boosted atherosclerosis development and a higher cardiovascular disease risk. This study aimed to delineate the role of anti-double stranded DNA (anti-dsDNA) antibodies on the molecular profile and the activity of immune and vascular cells, as well as on their enhanced cardiovascular risk. Approach and Results: Eighty SLE patients were included. Extensive clinical/analytical evaluation was performed, including cardiovascular disease parameters (endothelial function, proatherogenic dyslipidemia, and carotid intima-media thickness). Gene and protein expression profiles were evaluated in monocytes from patients diagnosed positive or negative for anti-dsDNA antibodies by using NanoString and cytokine arrays, respectively. NETosis and circulating inflammatory profile was assessed in both neutrophils and plasma. Positivity and persistence of anti-dsDNA antibodies in SLE patients were associated to endothelial dysfunction, proatherogenic dyslipidemia, and accelerated atherosclerosis. In parallel, anti-dsDNA antibodies were linked to the aberrant activation of innate immune cells, so that anti-dsDNA(+) SLE monocytes showed distinctive gene and protein expression/activity profiles, and neutrophils were more prone to suffer NETosis in comparison with anti-dsDNA(−) patients. Anti-dsDNA(+) patients further displayed altered levels of numerous circulating mediators related to inflammation, NETosis, and cardiovascular risk. In vitro, Ig-dsDNA promoted NETosis on neutrophils, apoptosis on monocytes, modulated the expression of inflammation and thrombosis-related molecules, and induced endothelial activation, at least partially, by FcR (Fc receptor)-binding mechanisms. Conclusions: Anti-dsDNA antibodies increase the cardiovascular risk of SLE patients by altering key molecular processes that drive a distinctive and coordinated immune and vascular activation, representing a potential tool in the management of this comorbidity.

scholarly journals Risk of Renal Failure Within 10 or 20 Years of Systemic Lupus Erythematosus Diagnosis

2020 ◽  
pp. jrheum.191094
Author(s):  
Michelle Petri ◽  
Erik Barr ◽  
Laurence S. Magder
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Failure ◽  
African American ◽  
Lupus Erythematosus ◽  
Strong Predictor ◽  
Large Population ◽  
The United States ◽  
First Year ◽  
Systemic Lupus ◽  
American Ethnicity

Objective The frequency of endstage renal disease (ESRD) from systemic lupus erythematosus (SLE) in the United States has not improved over the last few decades in large population datasets. Understanding the risk factors for renal failure in SLE could lead to earlier detection of lupus nephritis and potentially more effective treatments in those with markers of poor prognosis. Methods The Hopkins Lupus Cohort, comprising 2528 patients was used. One hundred fifty-one patients experienced renal failure after SLE diagnosis, defined as dialysis or renal transplant. We estimated the risk of renal failure in subgroups defined by demographics, laboratory tests, and the American College of Rheumatology/Systemic Lupus International Collaborating Clinics (ACR/SLICC) classification criteria satisfied within 1 year of SLE diagnosis. Results The overall incidence of renal failure within 20 years of SLE diagnosis was 8.4%. The risk was much higher (20.0%) among those who experienced proteinuria within the first year of diagnosis. Demographic predictors included African American ethnicity [rate ratio (RR) 1.82, P = 0.0012] and age ≥ 40 years at SLE diagnosis (RR 0.51 vs those with diagnosis at < 30 yrs of age, P = 0.019). Among immunologic markers, low C3 was a strong predictor of renal failure (RR 2.00, P = 0.0011). Conclusion Proteinuria within the first year of diagnosis of SLE is one of the most important predictors of ESRD. Our data also confirm African American ethnicity, younger age at SLE diagnosis, and low C3 as strong predictors of renal failure.

scholarly journals Imaging Assessment of Cardiovascular Disease in Systemic Lupus Erythematosus

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sara C. Croca ◽  
Anisur Rahman
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Lupus Erythematosus ◽  
Current Status ◽  
Systemic Lupus ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Cardiovascular Assessment

Systemic lupus erythematosus is a multisystem, autoimmune disease known to be one of the strongest risk factors for atherosclerosis. Patients with SLE have an excess cardiovascular risk compared with the general population, leading to increased cardiovascular morbidity and mortality. Although the precise explanation for this is yet to be established, it seems to be associated with the presence of an accelerated atherosclerotic process, arising from the combination of traditional and lupus-specific risk factors. Moreover, cardiovascular-disease associated mortality in patients with SLE has not improved over time. One of the main reasons for this is the poor performance of standard risk stratification tools on assessing the cardiovascular risk of patients with SLE. Therefore, establishing alternative ways to identify patients at increased risk efficiently is essential. With recent developments in several imaging techniques, the ultimate goal of cardiovascular assessment will shift from assessing symptomatic patients to diagnosing early cardiovascular disease in asymptomatic patients which will hopefully help us to prevent its progression. This review will focus on the current status of the imaging tools available to assess cardiac and vascular function in patients with SLE.

Systemic lupus erythematosus is a risk factor for cardiovascular disease: a nationwide, population-based study in Korea

Lupus ◽  
2018 ◽  
Vol 27 (13) ◽  
pp. 2050-2056 ◽  
Author(s):  
S Y Lim ◽  
E H Bae ◽  
K-D Han ◽  
J-H Jung ◽  
H S Choi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Lupus Erythematosus ◽  
Hazard Ratio ◽  
Systemic Lupus

Objective To investigate the incidence and clinical significance of cardiovascular disease in systemic lupus erythematosus patients. Methods We included systemic lupus erythematosus patients ( n = 18,575) without previous cardiovascular disease and age- and sex-matched individuals without systemic lupus erythematosus (controls; n = 92,875) from the Korean National Health Insurance Service database (2008–2014). Both cohorts were followed up for incident cardiovascular disease and death until 2015. Results During follow up, myocardial infarction occurred in 203 systemic lupus erythematosus patients and 325 controls (incidence rate: 1.76 and 0.56 per 1000 person-years, respectively), stroke occurred in 289 patients and 403 controls (incidence rate: 2.51 and 0.70 per 1000 person-years, respectively), heart failure occurred in 358 patients and 354 controls (incidence rate 3.11 and 0.61 per 1000 person-years, respectively), and death occurred in 744 patients and 948 controls (incidence rate 6.54 and 1.64 per 1000 person-years, respectively). Patients with systemic lupus erythematosus had higher risks for myocardial infarction (hazard ratio: 2.74, 95% confidence interval: 2.28–3.37), stroke (hazard ratio: 3.31, 95% confidence interval: 2.84–3.86), heart failure (hazard ratio: 4.60, 95% confidence interval: 3.96–5.35), and cardiac death (hazard ratio: 3.98, 95% confidence interval: 3.61–4.39). Conclusions Here, systemic lupus erythematosus was an independent risk factor for cardiovascular disease, thus cardiac assessment and management are critical in systemic lupus erythematosus patients.

Complementary role of cardiovascular imaging and laboratory indices in early detection of cardiovascular disease in systemic lupus erythematosus

Lupus ◽  
2016 ◽  
Vol 26 (3) ◽  
pp. 227-236 ◽  
Author(s):  
S Mavrogeni ◽  
L Koutsogeorgopoulou ◽  
T Dimitroulas ◽  
G Markousis-Mavrogenis ◽  
G Kolovou
Keyword(s):  
Heart Failure ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Lupus Erythematosus ◽  
Clinical Laboratory ◽  
Systemic Lupus ◽  
Invasive Approach ◽  
Cardiac Symptoms ◽  
Nuclear Techniques

Background Cardiovascular disease (CVD) has been documented in >50% of systemic lupus erythematosus (SLE) patients, due to a complex interplay between traditional risk factors and SLE-related factors. Various processes, such as coronary artery disease, myocarditis, dilated cardiomyopathy, vasculitis, valvular heart disease, pulmonary hypertension and heart failure, account for CVD complications in SLE. Methods Electrocardiogram (ECG), echocardiography (echo), nuclear techniques, cardiac computed tomography (CT), cardiovascular magnetic resonance (CMR) and cardiac catheterization (CCa) can detect CVD in SLE at an early stage. ECG and echo are the cornerstones of CVD evaluation in SLE. The routine use of cardiac CT and nuclear techniques is limited by radiation exposure and use of iodinated contrast agents. Additionally, nuclear techniques are also limited by low spatial resolution that does not allow detection of sub-endocardial and sub-epicardial lesions. CCa gives definitive information about coronary artery anatomy and pulmonary artery pressure and offers the possibility of interventional therapy. However, it carries the risk of invasive instrumentation. Recently, CMR was proved of great value in the evaluation of cardiac function and the detection of myocardial inflammation, stress-rest perfusion defects and fibrosis. Results An algorithm for CVD evaluation in SLE includes clinical, laboratory, ECG and echo assessment as well as CMR evaluation in patients with inconclusive findings, persistent cardiac symptoms despite normal standard evaluation, new onset of life-threatening arrhythmia/heart failure and/or as a tool to select SLE patients for CCa. Conclusions A non-invasive approach including clinical, laboratory and imaging evaluation is key for early CVD detection in SLE.

scholarly journals Metabolomics in juvenile-onset SLE: identifying new biomarkers to predict cardiovascular risk

2019 ◽  
Author(s):  
George A Robinson ◽  
Kirsty E Waddington ◽  
Leda Coelewij ◽  
Ania Radziszewska ◽  
Chris Wincup ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Atherosclerotic Plaque ◽  
Lupus Erythematosus ◽  
Metabolomic Analysis ◽  
Systemic Lupus ◽  
Juvenile Onset ◽  
Onset Systemic Lupus Erythematosus ◽  
Group 1

ABSTRACTBACKGROUNDJuvenile-onset systemic lupus erythematosus (JSLE) is an autoimmune disorder characterised by immune dysregulation, chronic inflammation and increased cardiovascular risk (CVR). Cardiovascular disease is the leading cause of mortality in JSLE patients not attributable to disease flares. However, it is not possible to predict those patients at greatest risk using traditional CVR factors.METHODSSerum metabolomic analysis was performed using a nuclear magnetic resonance spectroscopy-platform in 31 JSLE patients. Data was analysed using cluster, linear regression and receiver operating characteristic analysis. Results were validated in a second cohort of 31 JSLE patients and using data from a cohort of adult-onset SLE patients with known pre-clinical atherosclerotic plaque.RESULTSUnbiased hierarchical clustering of metabolomic data identified three patient groups. Group-1 had decreased atheroprotective high density lipoproteins (HDL) and increased atherogenic very low and low density lipoproteins (VLDL/LDL); Group-2 had elevated HDL but reduced VLDL/LDL; and Group-3 had low HDL/VLDL/LDL levels. Notably, apolipoprotein(Apo)B1:ApoA1 ratio, a known CVR marker in adult cohorts, was elevated in Group-1 JSLE patients compared to Groups-2/3. The metabolomic signature was validated in a second JSLE cohort and compared with lipid biomarkers previously associated with pre-clinical atherosclerotic plaque in adult SLE patients. Linear regression analysis accounting for demographics, treatment, disease activity, lupus serological markers and body mass index confirmed that a unique metabolomic profile could differentiate between JSLE patients at high and low CVR.CONCLUSIONSPatient stratification using ApoB:ApoA1 ratio and lipoprotein signatures could facilitate tailored lipid modification therapies and/or diet/lifestyle interventions to combat increased CVR in JSLE.Key messagesWhat is already known about the subject?Cardiovascular disease is the leading cause of mortality in juvenile-onset systemic lupus erythematosus (JSLE) not attributable to lupus flares; the cardiovascular risk of JSLE patients is 300 times higher than age matched healthy individuals. It is not possible to predict those patients at greatest risk using traditional risk factors.What does this study add?In depth lipoprotein-based metabolomic analysis identified Apolipoprotein(Apo)B :ApoA1 ratio as a potential biomarker for predicting increased cardiovascular risk in JSLE. This was validated in a second patient cohort and using metabolic signatures associated with pre-clinical atherosclerotic plaque development in adult SLE patients.How might this impact on clinical practice or future developments?Predicting cardiovascular risk in young JSLE patients using ApoB:ApoA1 ratio could help to stratify patients and identify those who would benefit the most from existing lipid targeting therapies. Reducing cardiovascular risk at a young age could improve patient’s life expectancy and quality of life and reduce cardiovascular comorbidity in later life.

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