Petri M, Perez-Gutthann S, Spence D, Hochberg M C
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Am J Med. 1992 Nov;93(5):513-9. doi: 10.1016/0002-9343(92)90578-y.
To estimate the frequency of and examine risk factors for coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE) in a prospective longitudinal study.
Patients were SLE are enrolled in The Johns Hopkins Lupus Cohort, a prospective study of outcomes in 229 subjects with SLE. CAD was defined as angina, myocardial infarction, or sudden death. Data on CAD risk factors were obtained prospectively every 3 months and were analyzed using univariate and multiple logistic regression.
CAD occurred in 19 (8.3%) of 229 patients with SLE and accounted for 3 (30%) of 10 deaths as of December 31, 1990. Compared to subjects without CAD, those with CAD were more likely to have been older at both diagnosis of SLE (37.1 years versus 28.9 years, p = 0.004) and at entry into the cohort (47.1 years versus 34.7 years, p < 0.0001), to have a longer mean duration of SLE (12.3 years versus 8.1 years, p = 0.013) and a longer mean duration of prednisone use (14.3 years versus 7.2 years, p < 0.0001), to have a higher mean serum cholesterol (271.2 mg/dL versus 214.9 mg/dL, p < 0.0001) or a cholesterol level greater than 200 mg/dL (odds ratio [OR] 14.5, 95% confidence intervals [CI] 1.9, 112.1), and to have both a history of hypertension (OR 3.5, 95% CI 1.3, 9.6) and a history of use of antihypertensive medications (OR 5.5, 95% CI 1.8, 17.2). There were no significant associations with other known CAD risk factors such as smoking, diabetes, family history of CAD, race, or sex, or variables related to steroid therapy including the presence of cushingoid features or ever use of corticosteroids. The best multiple logistic regression model for CAD included age at diagnosis, duration of prednisone use, requirement for antihypertensive treatment, maximum cholesterol level, and obesity (using NHANES-II [National Health and Nutrition Examination Survey] definitions).
Primary and secondary prevention strategies directed at hypertension, hypercholesterolemia, and obesity, as well as other known CAD risk factors, should be routinely employed in the management of patients with SLE.
在一项前瞻性纵向研究中，评估系统性红斑狼疮（SLE）患者冠状动脉疾病（CAD）的发生频率并检查其危险因素。
SLE患者被纳入约翰·霍普金斯狼疮队列研究，这是一项对229名SLE患者结局的前瞻性研究。CAD定义为心绞痛、心肌梗死或猝死。每3个月前瞻性获取CAD危险因素的数据，并使用单变量和多因素逻辑回归进行分析。
在229名SLE患者中，19例（8.3%）发生CAD，截至1990年12月31日，CAD占10例死亡病例中的3例（30%）。与无CAD的患者相比，有CAD的患者在SLE诊断时（37.1岁对28.9岁，p = 0.004）和进入队列时（47.1岁对34.7岁，p < 0.0001）年龄更大，SLE平均病程更长（12.3年对8.1年，p = 0.013），泼尼松使用平均时长更长（14.3年对7.2年，p < 0.0001），平均血清胆固醇水平更高（271.2mg/dL对214.9mg/dL，p < 0.0001）或胆固醇水平大于200mg/dL（比值比[OR]14.5，95%置信区间[CI]1.9，112.1），并且有高血压病史（OR 3.5，95%CI 1.3，9.6）和使用抗高血压药物史（OR 5.5，95%CI 1.8，17.2）。与其他已知的CAD危险因素如吸烟、糖尿病、CAD家族史、种族或性别，或与类固醇治疗相关的变量（包括库欣样特征的存在或曾使用皮质类固醇）无显著关联。预测CAD的最佳多因素逻辑回归模型包括诊断时年龄、泼尼松使用时长、抗高血压治疗需求、最高胆固醇水平和肥胖（使用美国国家健康和营养检查调查II [NHANES-II]的定义）。
在SLE患者的管理中，应常规采用针对高血压、高胆固醇血症和肥胖以及其他已知CAD危险因素的一级和二级预防策略。
