Minority patients with systemic lupus erythematosus (SLE) had high rates of coronary artery calcification, even at very young ages, researchers found.
Among a cohort of patients that was 40% African-American and 33% Hispanic, 42.1% had detectable coronary artery calcification, with scores above zero, according to Yevgeniya Gartshteyn, MD, of Columbia University in New York City, and colleagues.
And among those who were ages 18 to 32, coronary artery calcium scores above zero already were detected in 29%, the researchers reported online in Lupus Science & Medicine.
Cardiovascular disease is a major cause of death among patients with SLE, and conventional risk assessment tools are unreliable for these patients, so better methods of estimating cardiovascular risk are needed.
Coronary artery calcification scores estimate the degree of calcified plaque, and scores above zero have been shown to independently predict mortality in the overall population. Previous studies also have found high rates of calcification among patients with SLE, but the patients in those studies were predominantly white.
To examine rates among minority patients, Gartshteyn's group enrolled 76 patients from the Columbia University Lupus Cohort who had no history of coronary artery disease and had chest CT performed and calcification scores calculated.
Population controls consisted of participants ages 33 to 45 in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort.
Coronary artery calcification scores were analyzed as a dichotomous variable of any detectable calcification (scores above zero) and as categorical variables with scores of zero, 1 to 99, 100 to 399, and 400 or higher. Covariates included hypertension, diabetes, SLE severity and damage, and laboratory variables such as lipids and autoantibodies.
Patients' mean age was 40 years, 90% were women, and disease activity was moderate. All had antinuclear antibodies present and two-thirds had high levels of double-stranded anti-DNA antibodies. Hypertension was diagnosed in 43% and diabetes in 10%, and 15% reported a history of smoking. Systemic glucocorticoids had been used by 90%, aspirin by 29%, and statins by 13%.
Patients who had any detectable calcification tended to be older (45 vs 37 years, P=0.01) and more often were hypertensive (56% vs 35%, P=0.05). Prevalence increased with older age, reaching 42.1% in those ages 33 to 44 and 61.6% in those 45 to 64.
Scores in the 1 to 99 range were observed in 30%, in the 100 to 399 range in 8%, and above 400 in 4%.
The 50 SLE patients who were ages 45 or younger were then compared with 3,042 CARDIA controls who also were no older than 45. The SLE patients were predominantly female (92% vs 54%, P<0.001), and were less often identified as white (6% vs 55%, P<0.001). SLE patients also more often had hypertension (44% vs 23%, P<0.001) and used aspirin (32% vs 7%, P<0.001).
Compared with the CARDIA controls, patients with SLE had a significantly higher prevalence of calcification scores above zero (32% vs 9.6%, P<0.001), with an odds ratio of 4.5 (95% CI 2.4-8.2). After adjustment for age, sex, hypertension, cholesterol, and aspirin use, the odds ratio for having a calcium score above zero in SLE patients younger than 45 was 12.6 (95% CI 5.2-30.7).
"Importantly," the high prevalence of coronary artery calcium scores above zero in patients with SLE younger than 45 is similar to the 43% that has been reported for patients ages 40 and younger with diabetes, the authors noted.
A previous study estimated that calcification scores of 100 or higher corresponded with a 10-year cardiovascular event rate of 7.5%, a rate that was seen in the current study in 16% of patients ages 33 to 45 and in 23% of those 46 to 64. However, with an expectation of annual worsening of calcification scores of 20 units per year, a female patient in her 20s whose score was only in the 1-to-99 range could have a score above 300 by the time she was 50. The subsequent 10-year cardiovascular event risk could be 13-25%, Gartshteyn and co-authors calculated.
"The high prevalence in this young, predominantly female minority population is disquieting and warrants further investigation and longitudinal follow-up," the researchers concluded.
A limitation of the study, they said, was the different methods of CT used in this analysis and in CARDIA.
The authors reported no financial conflicts.
Home-Based Cardiac Rehabilitation jacc: Journal of the
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