WESTPORT, CT (Reuters Health) – In patients with systemic lupus erythematosus (SLE), the risk of coronary heart disease and stroke far outstrips what would be predicted on the basis of traditional Framingham risk factors alone, investigators in Canada report.
A second group of investigators has determined that decreased bone mineral density (BMD) is associated with increased carotid plaque index and the presence of coronary artery calcification in younger women with SLE.
Dr. John M. Esdaile, of the Arthritis Research Centre of Canada in Vancouver, and associates identified 263 patients with SLE who had not experienced stroke or a CHD event (nonfatal myocardial infarction, CHD death, angina, congestive heart failure). They evaluated baseline risk factors, including age, smoking status, blood pressure, cholesterol, diabetes status and presence/absence of left ventricular hypertrophy.
Patients were followed from 1977 or 1983 until 1996. As reported in Arthritis and Rheumatism for October, 16.7% experienced a CHD event, a stroke, or both during followup. This risk was more than 7 times higher than what would be expected based on vascular risk factors in the Framingham model, Dr. Esdaile's group calculated. The risk of nonfatal MI was increased 10-fold and the risk of CHD death was increased 17-fold.
The Canadian researchers suggest a number of factors that may contribute to the increased risk: "immune complex-induced endothelial damage, vasculitis, antiphospholipid antibody-induced thrombosis, the effects of Libman-Sacks endocarditis, hypertension from renal involvement or corticosteroid therapy, and corticosteroid-induced central obesity, hyperglycemia, or hypercholesterolemia."
In the second study, reported in the same issue of the journal, Dr. Rosalind Ramsey-Goldman, of Northwestern University Medical School in Chicago, and Dr. Susan Manzi, of the University of Pittsburgh School of Medicine, conducted B-mode carotid ultrasound and dual x-ray absorptiometry on 65 women with SLE, mean age <45 years.
The carotid plaque index was 1.00 for patients in the lowest and middle tertiles of total hip BMD and 0.38 for those in the highest tertile. Drs. Ramsey-Goldman and Manzi also observed an association between BMD and coronary artery calcification measured by electron beam computed tomography.
In an editorial, Dr. Michael D. Lockshin and associates from Cornell University in New York suggest that studies such as these will allow physicians "to explore the next great frontier of lupus: prevention of long-term atherosclerosis-associated disability."
Arthritis Rheum 2001;44:2331-2341,2215-2217.
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