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Author Notes:

Correspondence to Dr Murray B Urowitz; m.urowitz@utoronto.ca

All authors were involved in the study conception and design, acquisition of data, and analysis and interpretation of data. All authors have contributed to this work to a significant extent and have read and approved the submitted version.

The authors gratefully acknowledge the generous donation of our patients' time and the dedication of all the fellows, research coordinators and assistants in the SLICC group to the completion of this work.

Competing interests: None declared.

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Research Funding:

The authors would like to acknowledge the financial support of the Canadian Institutes of Health Research, Lupus UK, Tolfo Family, Lupus Ontario and the Conn Smythe Foundation.

Keywords:

  • Cardiovascular Disease
  • Inflammation
  • Systemic Lupus Erythematosus

Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort.

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Journal Title:

Lupus Science & Medicine

Volume:

Volume 3, Number 1

Publisher:

, Pages e000143-e000143

Type of Work:

Article | Final Publisher PDF

Abstract:

OBJECTIVE: To describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up. METHODS: The systemic lupus international collaborating clinics (SLICC) atherosclerosis inception cohort enters patients within 15 months of SLE diagnosis. MIs were reported and attributed on a specialised vascular event form. MIs were confirmed by one or more of the following: abnormal ECG, typical or atypical symptoms with ECG abnormalities and elevated enzymes (≥2 times upper limit of normal), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used. RESULTS: 31 of 1848 patients who entered the cohort had an MI. Of those, 23 patients had an MI prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied, 60.9% were female, 78.3% were Caucasian, 8.7% black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5±15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1±7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up. Risk factors associated with early MI in univariate analysis are male sex, Caucasian, older age at diagnosis, hypertension, hypercholesterolaemia, family history of MI and smoking. In multivariate analysis only age (OR=1.06 95% CI 1.03 to 1.09), hypertension (OR=5.01, 95% CI 1.38 to 18.23), hypercholesterolaemia (OR=4.43, 95% CI 1.51 to 12.99) and smoking (OR=7.50, 95% CI 2.38 to 23.57) remained significant risk factors. CONCLUSIONS: In some patients with lupus, MI may develop even before the diagnosis of SLE or shortly thereafter, suggesting that there may be a link between autoimmune inflammation and atherosclerosis.

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This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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