Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort

Murray B. Urowitz; Dafna D. Gladman; Vernon Farewell; Jiandong Su; Juanita Romero-Diaz; Sang-Cheol Bae; Paul R. Fortin; Jorge Sanchez-Guerrero; Ann Elaine Clarke; Sasha Bernatsky; Caroline Gordon; John G. Hanly; Daniel J. Wallace; David A. Isenberg; Anisur Rahman; Joan T. Merrill; Ellen Ginzler; Graciela S. Alarcón; W. Winn Chatham; Michelle A. Petri; Ian N. Bruce; Munther A. Khamashta; Cynthia Aranow; Mary Anne Dooley; Susan Manzi; Rosalind Ramsey-Goldman; Ola Nived; Andreas Jönsen; Kristján Steinsson; Asad A. Zoma; Guillermo Ruiz-Irastorza; S. Sam Lim; Kenneth C. Kalunian; Murat Ỉnanç; Ronald van Vollenhoven; Manuel Ramos-Casals; Diane L. Kamen; Soren Jacobsen; Christine A. Peschken; Anca Askanase; Thomas Stoll

doi:10.1002/art.41392

Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort

Murray B. Urowitz^*
, Dafna D. Gladman
, Vernon Farewell
, Jiandong Su
, Juanita Romero-Diaz
, Sang-Cheol Bae
, Paul R. Fortin
, Jorge Sanchez-Guerrero
, Ann Elaine Clarke
, Sasha Bernatsky
, Caroline Gordon
, John G. Hanly
, Daniel J. Wallace
, David A. Isenberg
, Anisur Rahman
, Joan T. Merrill
, Ellen Ginzler
, Graciela S. Alarcón
, W. Winn Chatham
, Michelle A. Petri

Ian N. Bruce, Munther A. Khamashta, Cynthia Aranow, Mary Anne Dooley, Susan Manzi, Rosalind Ramsey-Goldman, Ola Nived, Andreas Jönsen, Kristján Steinsson, Asad A. Zoma, Guillermo Ruiz-Irastorza, S. Sam Lim, Kenneth C. Kalunian, Murat Ỉnanç, Ronald van Vollenhoven, Manuel Ramos-Casals, Diane L. Kamen, Soren Jacobsen, Christine A. Peschken, Anca Askanase, Thomas Stoll

^*Corresponding author for this work

University of Toronto
University of Cambridge
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Hanyang University
Université Laval
University of Calgary
McGill University
University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
QEII Health Sciences Centre
University of California at Los Angeles
University College London
Oklahoma Medical Research Foundation
SUNY Downstate Health Sciences University
University of Alabama at Birmingham
Johns Hopkins University
University of Manchester
St Thomas’ Hospital and King’s College London School of Medicine, London, UK
Northwell Health System
University of North Carolina at Chapel Hill
West Penn Allegheny Health System
Northwestern University
Lund University
Landspitali University Hospital
NHS Lanarkshire
University of the Basque Country
Emory University
University of California at San Diego
Istanbul University
August Pi i Sunyer Biomedical Research Institute
Medical University of South Carolina
University of Copenhagen
University of Manitoba
New York University
Olten Cantonal Hospital
University of Birmingham College of Medical and Dental Sciences
King's College London

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Abstract

Objective: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. Results: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32–0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55–10.30]) and a body mass index of >40 kg/m ² (HR 2.74 [95% CI 1.04–7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17–9.27], P < 0.001). Conclusion: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.

Original language	English
Pages (from-to)	1734-1740
Number of pages	7
Journal	Arthritis & rheumatology (Hoboken, N.J.)
Volume	72
Issue number	10
Early online date	2020
DOIs	https://doi.org/10.1002/art.41392
Publication status	Published - 1 Oct 2020

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Urowitz, M. B., Gladman, D. D., Farewell, V., Su, J., Romero-Diaz, J., Bae, S.-C., Fortin, P. R., Sanchez-Guerrero, J., Clarke, A. E., Bernatsky, S., Gordon, C., Hanly, J. G., Wallace, D. J., Isenberg, D. A., Rahman, A., Merrill, J. T., Ginzler, E., Alarcón, G. S., Chatham, W. W., ... Stoll, T. (2020). Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort. Arthritis & rheumatology (Hoboken, N.J.), 72(10), 1734-1740. https://doi.org/10.1002/art.41392

@article{53ca268b70b0478787200ffb18fa9894,

title = "Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort",

abstract = "Objective: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in \textasciitilde{}10\% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. Results: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6\% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95\% confidence interval (95\% CI) 0.32–0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95\% CI 1.55–10.30]) and a body mass index of >40 kg/m 2 (HR 2.74 [95\% CI 1.04–7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95\% CI 3.17–9.27], P < 0.001). Conclusion: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors. ",

author = "Urowitz, \{Murray B.\} and Gladman, \{Dafna D.\} and Vernon Farewell and Jiandong Su and Juanita Romero-Diaz and Sang-Cheol Bae and Fortin, \{Paul R.\} and Jorge Sanchez-Guerrero and Clarke, \{Ann Elaine\} and Sasha Bernatsky and Caroline Gordon and Hanly, \{John G.\} and Wallace, \{Daniel J.\} and Isenberg, \{David A.\} and Anisur Rahman and Merrill, \{Joan T.\} and Ellen Ginzler and Alarc{\'o}n, \{Graciela S.\} and Chatham, \{W. Winn\} and Petri, \{Michelle A.\} and Bruce, \{Ian N.\} and Khamashta, \{Munther A.\} and Cynthia Aranow and Dooley, \{Mary Anne\} and Susan Manzi and Rosalind Ramsey-Goldman and Ola Nived and Andreas J{\"o}nsen and Kristj{\'a}n Steinsson and Zoma, \{Asad A.\} and Guillermo Ruiz-Irastorza and Lim, \{S. Sam\} and Kalunian, \{Kenneth C.\} and Murat Ỉnan{\c c} and \{van Vollenhoven\}, Ronald and Manuel Ramos-Casals and Kamen, \{Diane L.\} and Soren Jacobsen and Peschken, \{Christine A.\} and Anca Askanase and Thomas Stoll",

year = "2020",

month = oct,

day = "1",

doi = "10.1002/art.41392",

language = "English",

volume = "72",

pages = "1734--1740",

journal = "Arthritis \& rheumatology (Hoboken, N.J.)",

issn = "2326-5191",

publisher = "John Wiley and Sons Ltd.",

number = "10",

}

Urowitz, MB, Gladman, DD, Farewell, V, Su, J, Romero-Diaz, J, Bae, S-C, Fortin, PR, Sanchez-Guerrero, J, Clarke, AE, Bernatsky, S, Gordon, C, Hanly, JG, Wallace, DJ, Isenberg, DA, Rahman, A, Merrill, JT, Ginzler, E, Alarcón, GS, Chatham, WW, Petri, MA, Bruce, IN, Khamashta, MA, Aranow, C, Dooley, MA, Manzi, S, Ramsey-Goldman, R, Nived, O, Jönsen, A, Steinsson, K, Zoma, AA, Ruiz-Irastorza, G, Lim, SS, Kalunian, KC, Ỉnanç, M, van Vollenhoven, R, Ramos-Casals, M, Kamen, DL, Jacobsen, S, Peschken, CA, Askanase, A & Stoll, T 2020, 'Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort', Arthritis & rheumatology (Hoboken, N.J.), vol. 72, no. 10, pp. 1734-1740. https://doi.org/10.1002/art.41392

TY - JOUR

T1 - Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort

AU - Urowitz, Murray B.

AU - Gladman, Dafna D.

AU - Farewell, Vernon

AU - Su, Jiandong

AU - Romero-Diaz, Juanita

AU - Bae, Sang-Cheol

AU - Fortin, Paul R.

AU - Sanchez-Guerrero, Jorge

AU - Clarke, Ann Elaine

AU - Bernatsky, Sasha

AU - Gordon, Caroline

AU - Hanly, John G.

AU - Wallace, Daniel J.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Merrill, Joan T.

AU - Ginzler, Ellen

AU - Alarcón, Graciela S.

AU - Chatham, W. Winn

AU - Petri, Michelle A.

AU - Bruce, Ian N.

AU - Khamashta, Munther A.

AU - Aranow, Cynthia

AU - Dooley, Mary Anne

AU - Manzi, Susan

AU - Ramsey-Goldman, Rosalind

AU - Nived, Ola

AU - Jönsen, Andreas

AU - Steinsson, Kristján

AU - Zoma, Asad A.

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S. Sam

AU - Kalunian, Kenneth C.

AU - Ỉnanç, Murat

AU - van Vollenhoven, Ronald

AU - Ramos-Casals, Manuel

AU - Kamen, Diane L.

AU - Jacobsen, Soren

AU - Peschken, Christine A.

AU - Askanase, Anca

AU - Stoll, Thomas

PY - 2020/10/1

Y1 - 2020/10/1

N2 - Objective: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. Results: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32–0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55–10.30]) and a body mass index of >40 kg/m 2 (HR 2.74 [95% CI 1.04–7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17–9.27], P < 0.001). Conclusion: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.

AB - Objective: In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. Methods: A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. Results: Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32–0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55–10.30]) and a body mass index of >40 kg/m 2 (HR 2.74 [95% CI 1.04–7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17–9.27], P < 0.001). Conclusion: The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.

UR - https://www.scopus.com/pages/publications/85089782157

U2 - 10.1002/art.41392

DO - 10.1002/art.41392

M3 - Article

C2 - 32515554

SN - 2326-5191

VL - 72

SP - 1734

EP - 1740

JO - Arthritis & rheumatology (Hoboken, N.J.)

JF - Arthritis & rheumatology (Hoboken, N.J.)

IS - 10

ER -

Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort

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