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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Arthritis+Res+Ther
2012 ; 14
(2
): R46
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Risk factors for cardiovascular mortality in patients with systemic lupus
erythematosus, a prospective cohort study
#MMPMID22390680
Gustafsson JT
; Simard JF
; Gunnarsson I
; Elvin K
; Lundberg IE
; Hansson LO
; Larsson A
; Svenungsson E
Arthritis Res Ther
2012[]; 14
(2
): R46
PMID22390680
show ga
INTRODUCTION: Systemic 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). METHODS: 208 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.
RESULTS: During 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. CONCLUSION: With 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.