Document Detail

Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus.
MedLine Citation:
PMID:  14681505     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although systemic lupus erythematosus is associated with premature myocardial infarction, the prevalence of underlying atherosclerosis and its relation to traditional risk factors for cardiovascular disease and lupus-related factors have not been examined in a case-control study. METHODS: In 197 patients with lupus and 197 matched controls, we performed carotid ultrasonography, echocardiography, and an assessment for risk factors for cardiovascular disease. The patients were also evaluated with respect to their clinical and serologic features, inflammatory mediators, and disease treatment. RESULTS: The risk factors for cardiovascular disease were similar among patients and controls. Atherosclerosis (carotid plaque) was more prevalent among patients than the controls (37.1 percent vs. 15.2 percent, P<0.001). In multivariate analysis, only older age, the presence of systemic lupus erythematosus (odds ratio, 4.8; 95 percent confidence interval, 2.6 to 8.7), and a higher serum cholesterol level were independently related to the presence of plaque. As compared with patients without plaque, patients with plaque were older, had a longer duration of disease and more disease-related damage, and were less likely to have multiple autoantibodies or to have been treated with prednisone, cyclophosphamide, or hydroxychloroquine. In multivariate analyses including patients with lupus, independent predictors of plaque were a longer duration of disease, a higher damage-index score, a lower incidence of the use of cyclophosphamide, and the absence of anti-Smith antibodies. CONCLUSIONS: Atherosclerosis occurs prematurely in patients with systemic lupus erythematosus and is independent of traditional risk factors for cardiovascular disease. The clinical profile of patients with lupus and atherosclerosis suggests a role for disease-related factors in atherogenesis and underscores the need for trials of more focused and effective antiinflammatory therapy.
Mary J Roman; Beth-Ann Shanker; Adrienne Davis; Michael D Lockshin; Lisa Sammaritano; Ronit Simantov; Mary K Crow; Joseph E Schwartz; Stephen A Paget; Richard B Devereux; Jane E Salmon
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  349     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-18     Completed Date:  2003-12-23     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2399-406     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2003 Massachusetts Medical Society
Division of Cardiology, Weill Medical College of Cornell University, the Hospital for Special Surgery, New York, NY 10021, USA.
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MeSH Terms
Adrenal Cortex Hormones / therapeutic use
Age Factors
Arteriosclerosis / epidemiology,  etiology*,  ultrasonography
Autoantibodies / blood
C-Reactive Protein / analysis
CD40 Ligand / blood
Cardiovascular Diseases
Carotid Artery Diseases / epidemiology,  etiology*,  ultrasonography
Case-Control Studies
Logistic Models
Lupus Erythematosus, Systemic / complications*,  drug therapy,  immunology
Middle Aged
Multivariate Analysis
Risk Factors
Grant Support
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Autoantibodies; 147205-72-9/CD40 Ligand; 9007-41-4/C-Reactive Protein
Comment In:
N Engl J Med. 2004 Apr 8;350(15):1571-5; author reply 1571-5   [PMID:  15074008 ]
N Engl J Med. 2004 Apr 8;350(15):1571-5; author reply 1571-5   [PMID:  15074009 ]
N Engl J Med. 2004 Apr 8;350(15):1571-5; author reply 1571-5   [PMID:  15071134 ]
N Engl J Med. 2004 Apr 8;350(15):1571-5; author reply 1571-5   [PMID:  15074010 ]
N Engl J Med. 2004 Apr 8;350(15):1571-5; author reply 1571-5   [PMID:  15074011 ]
N Engl J Med. 2003 Dec 18;349(25):2379-80   [PMID:  14681501 ]
Erratum In:
N Engl J Med. 2006 Oct 19;355(16):1746

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