Abstract
IntroductionSystemic lupus erythematosus (SLE) is a chronic autoimmune disease. Cardiovascular disease (CVD) is common and a major cause of mortality. Studies on cardiovascular morbidity are abundant, whereas mortality studies focusing on cardiovascular outcomes are scarce. The aim of this study was to investigate causes of death and baseline predictors of overall (OM), non-vascular (N-VM), and specifically cardiovascular (CVM) mortality in SLE, and to evaluate systematic coronary risk evaluation (SCORE).Methods208 SLE patients were included 1995-1999 and followed up after 12 years. Clinical evaluation, CVD risk factors, and biomarkers were recorded at inclusion. Death certificates and autopsy protocols were collected. Causes of death were divided into CVM (ischemic vascular and general atherosclerotic diseases), N-VM and death due to pulmonary hypertension. Predictors of mortality were investigated using multivariable Cox regression. SCORE and standardized mortality ratio (SMR) were calculated.ResultsDuring follow-up 42 patients died at mean age of 62 years. SMR 2.4 (CI 1.7-3.0). 48% of deaths were caused by CVM. SCORE underestimated CVM but not to a significant level. Age, high cystatin C levels and established arterial disease were the strongest predictors for all- cause mortality. After adjusting for these in multivariable analyses, only smoking among traditional risk factors, and high soluble vascular cell adhesion molecule-1 (sVCAM-1), high sensitivity C-reactive protein (hsCRP), anti-beta2 glycoprotein-1 (abeta2GP1) and any antiphospholipid antibody (aPL) among biomarkers, remained predictive of CVM.ConclusionWith the exception of smoking, traditional risk factors do not capture the main underlying risk factors for CVM in SLE. Rather, cystatin C levels, inflammatory and endothelial markers, and antiphospholipid antibodies (aPL) differentiate patients with favorable versus severe cardiovascular prognosis. Our results suggest that these new biomarkers are useful in evaluating the future risk of cardiovascular mortality in SLE patients.
Highlights
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease
standardized mortality ratio (SMR) 2.4 (CI 1.7-3.0). 48% of deaths were caused by cardiovascular mortality (CVM)
CVM was the predominant cause of death (n = 20, 48%) (Table 1)
Summary
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. The aim of this study was to investigate causes of death and baseline predictors of overall (OM), non-vascular (N-VM), and cardiovascular (CVM) mortality in SLE, and to evaluate systematic coronary risk evaluation (SCORE). Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease predominately affecting women (90%). Cardiovascular disease (CVD) is a well studied co-morbidity of SLE with many remaining questions to be answered. A slight increased standardized mortality ratio (SMR) due to vascular diseases has been reported [15], and death from CVD accounts for between 17% and 76% in different studies [16,17]. Many new biomarkers that could help identify underlying molecular pathways of importance for vascular damage, such as endothelial and inflammatory markers and cystatin C have not been evaluated with respect to mortality in SLE
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
