Systemic lupus erythematosus risk factors for coronary artery calcifications

Romero-Díaz, Juanita; Vargas-Voráckóva, Florencia; Kimura-Hayama, Erick; Cortázar-Benítez, Luis Fernando; Gijón-Mitre, Rubén; Críales, Sergio; Cabiedes-Contreras, Javier; Iñiguez-Rodríguez, María del Rocío; Lara-García, Eunice Alejandra; Núñez‐Álvarez, Carlos A.; Llórente, Luis; Aguilar-Salinas, Carlos A.; Sánchez‐Guerrero, Jorge

doi:10.1093/rheumatology/ker307

Cited by 84 publications

(59 citation statements)

References 31 publications

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“…Several other studies have failed to show an association of SLE disease activity with subclinical measures of atherosclerosis 38,39,40 . A recent study of 139 patients with SLE found that a longer period with moderate to severe activity (as measured by SLEDAI) was associated with coronary artery calcium 41 . A Canadian study also found that disease activity as measured by SLEDAI was associated with risk for coronary artery disease 42 .…”

Section: Discussionmentioning

confidence: 99%

Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

2012

J Rheumatol

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Objective-A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE.Methods-Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.Results-The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant. Conclusion-Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers. Key Indexing Terms SYSTEMIC LUPUS ERYTHEMATOSUS; CARDIOVASCULAR DISEASE; RISK FACTORS; COMORBIDITYCardiovascular disease, specifically from accelerated premature atherosclerosis, is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) 1 . Patients with SLE are 2 to 9 times more likely than the general population to have myocardial infarctions 2,3,4 . The pathogenesis is multifactorial, including traditional cardiovascular risk factors, but also corticosteroids and inflammatory pathways 5,6,7,8 . The risk of an acute cardiac event is affected by the presence, extent, location, characteristics, and metabolic activity of coronary atherosclerotic plaque 13,14,15 . Noncalcified plaque may be more metabolically active than highly calcified plaque and preliminary data suggest that the presence of noncalcified or only partially calcified plaques is associated with greater risk of unstable presentation 16 . Motoyama, et al reported that the appearance of low attenuation plaque on multidetector CT was an independent predictor of acute coronary syndrome events for a 2-year followup period 17 . Noncalcified plaque may be present in the absence of coronary artery calcification: in a Japanese study, the prevalence of noncalcified plaque was 11.1% in patients with no coronary artery calcium and 23.4% in patients with mild coronary artery calcium 18 .In our previous study of noncalcified plaque in SLE, we found that 54% of patients with SLE h...

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Section: Discussionmentioning

confidence: 99%

Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

2012

J Rheumatol

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“…Silent myocardial infarction has been also diagnosed by myocardial perfusion SPECT in SLE [43] . Additionally, abnormal perfusion was identified in asymptomatic, factor [55] . Finally, another CT study demonstrated that the calcification of cardiac valves is more prevalent in RA and SLE, compared with controls.…”

Section: Single-photon Emission Computed Tomographymentioning

confidence: 95%

“How many times must a man look up before he can really see the sky?” Rheumatic cardiovascular disease in the era of multimodality imaging

Mavrogeni

Markousis‐Mavrogenis

Heutemann

et al. 2015

WJM

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Cardiovascular involvement in rheumatic diseases (RD) is the result of various pathophysiologic mechanisms including inflammation, accelerated atherosclerosis, myocardial ischemia, due to micro-or macro-vascular lesions and fibrosis. Noninvasive cardiovascular imaging, including echocardiography, nuclear techniques, cardiovascular computed tomography and cardiovascular magnetic resonance, represents the main diagnostic tool for early, non-invasive diagnosis of heart disease in RD. However, in the era of multimodality imaging and financial crisis there is an imperative need for rational use of imaging techniques in order to obtain the maximum benefit at the lowest possible cost for the health insurance system. The oligo-asymptomatic cardiovascular presentation and the high cardiovascular mortality of RD necessitate a reliable and reproducible diagnostic approach to catch early cardiovascular involvement. Echocardiography remains the routine cornerstone of cardiovascular evaluation. However, a normal echocardiogram can not always exclude cardiac involvement and/or identify heart disease acuity and pathophysiology. Therefore, cardiovascular magnetic resonance is a necessary adjunct complementary to echocardiography, especially in new onset heart failure and when there are conflicting data from clinical, electrocardiographic and echocardiographic evaluation of RD patients.

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“…One inception cohort study found no association between disease activity (measured using SLEDAI-2K) and cardiovascular events [27], while several other studies found that higher SLEDAI scores did predict MI and /or stroke [28–30]. Similarly, although one study found that higher mean disease activity scores were significantly associated with subclinical atherosclerosis (increased coronary calcium scores) [31]; Manzi et al found an inverse relationship between SLE activity and carotid plaque [32], while several other studies found no association between disease activity and progression of atherosclerosis [33–35]. Renal disease activity also appears to be a risk factor for atherosclerosis in patients with SLE; in one large study, both pediatric and adult patients with ESRD and SLE had significantly higher mortality due to cardiovascular disease than age-matched non-SLE patients with ESRD [36].…”

Section: Sle Specific Risk Factorsmentioning

confidence: 99%