Age-specific Incidence Rates of Myocardial Infarction and Angina in Women with Systemic Lupus Erythematosus: Comparison with the Framingham Study

Abstract

The authors ascertained cardiovascular events (myocardial infarction and angina pectoris) in 498 women with systemic lupus erythematosus seen at the University of Pittsburgh Medical Center from 1980 to 1993 (3,522 person-years). Subjects were stratified by age, and cardiovascular event incidence rates were determined. The authors compared these rates with cardiovascular event rates were determined. The authors compared these rates with cardiovascular event rates occurring over the same time period in 2,208 women of similar age participating in the Framingham Offspring Study (17,519 person-years). Age-specific rate ratios were computed to determine whether the cardiovascular events in the lupus cohort were greater than expected. The risk factors associated with cardiovascular events in women with lupus were determined. There were 33 first events (11 myocardial infarction, 10 angina pectoris, and 12 both angina pectoris and myocardial infarction) after the diagnosis of lupus: two thirds were under the age of 55 years at the time of event. Women with lupus in the 35- to 44-year age group were over 50 times more likely to have a myocardial infarction than were women of similar age in the Framingham Offspring Study (rate ratio = 52.43, 95% confidence interval 21.6-98.5). Older age at lupus diagnosis, longer lupus disease duration, longer duration of corticosteroid use, hypercholesterolemia, and postmenopausal status were more common in the women with lupus who had a cardiovascular event than in those who did not have an event. Premature cardiovascular disease is much more common in young premenopausal women with lupus than in a population sample. With the increased life expectancy of lupus patients due to improved therapy, cardiovascular disease has emerged as a significant threat to the health of these women. The impact of this problem has been underrecognized, with little focus placed on aggressive management of hypercholesterolemia and other possible risk factors.

Menopause hormonal therapy in women with systemic lupus erythematosus

“…In conclusion, since women with SLE are at an increased risk of developing premature menopause (2), osteoporotic fractures (44), cognitive dysfunction (45), premature atherosclerosis (46), thrombosis (40), and cardiovascular events (47), and their quality of life often is poorer than that of the general population (48), the effects of menopause in addition to these conditions, and the risk-benefit profile of menopause hormonal therapy in these women and those with other chronic diseases, need to be explored in depth. Menopause hormonal therapy did not affect the course of disease activity, at a clinically significant level, in women with SLE who were in the menopausal transition or in early or late postmenopause.…”

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

“…The risk appears to accumulate over time and persists after adjustment for other cardiovascular risk factors (relative risk of MI is greater than three after 10 years of having the disease) [6,12] suggesting that RA independently doubles the hazard for myocardial infarction and sudden cardiac death. The degree of increased risk of myocardial infarction in SLE patients varies, with risks as high as 50-fold in premenopausal women and decreasing to the risk of the general population in the elderly [13][14][15]. The nurses' health study found a slightly greater than twofold risk of cardiovascular disease in lupus patients [16].…”

Whole blood viscosity and arterial thrombotic events in patients with systemic lupus erythematosus

“…The estimated 5-year risk of arterial thrombosis ranges from 5.1% to 8.5%, while 5-year venous thrombosis risk ranges from 3.7% to 10.3% (1). Consequently, patients with SLE have a significantly increased risk of premature cerebrovascular accident (CVA) and myocardial infarction (MI) compared with agematched controls (2)(3)(4)(5). Although most studies document a role of traditional cardiovascular risk factors, the increased incidence of cardiovascular disease in SLE cannot be explained by traditional risk factors alone, suggesting that there are additional factors contributing to atherothrombotic disease in SLE (3,4,6 -8).…”