Hak A Elisabeth, Karlson Elizabeth W, Feskanich Diane, Stampfer Meir J, Costenbader Karen H
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Arthritis Rheum. 2009 Oct 15;61(10):1396-402. doi: 10.1002/art.24537.
Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular disease. However, prospective population-based data addressing this association have been lacking.
We conducted a prospective cohort study among 119,332 women participating in the Nurses' Health Study who were free of cardiovascular disease and SLE at baseline in 1976. Incident SLE was confirmed by medical record review. Cardiovascular events included fatal and nonfatal myocardial infarction, stroke, coronary artery bypass grafting, and angioplasty. The relative risk (RR) of cardiovascular events among participants with SLE as compared with those without SLE was estimated using Cox proportional hazards models.
Over 28 years of followup (2.9 million person-years), 8,169 cardiovascular events occurred and 148 women developed incident SLE. The mean age at SLE diagnosis was 52.6 years, and 20 participants with SLE developed a subsequent cardiovascular event. After adjusting for potential confounding factors, including age, race, cardiovascular risk factors, and medication use, the RR of a cardiovascular event in women with SLE compared with those without SLE was 2.26 (95% confidence interval [95% CI] 1.45-3.52). When end points were analyzed separately, the RR for coronary heart disease was 2.25 (95% CI 1.37-3.69) and the RR for stroke was 2.29 (95% CI 0.85-6.15).
In this prospective population-based study, we found a statistically significant >2-fold increased risk of cardiovascular disease among participants with SLE. The risk was not as high as has been previously reported, which may have been due to the relatively high age at diagnosis of SLE in this cohort.
系统性红斑狼疮（SLE）与心血管疾病风险增加相关。然而，此前缺乏基于人群的前瞻性数据来阐明这种关联。
我们对119332名参与护士健康研究的女性进行了一项前瞻性队列研究，这些女性在1976年基线时无心血管疾病和SLE。通过病历审查确诊新发SLE。心血管事件包括致命和非致命性心肌梗死、中风、冠状动脉搭桥术和血管成形术。使用Cox比例风险模型估计SLE患者与无SLE患者相比发生心血管事件的相对风险（RR）。
经过28年的随访（290万人年），发生了8169例心血管事件，148名女性出现新发SLE。SLE诊断时的平均年龄为52.6岁，20名SLE患者随后发生了心血管事件。在调整了包括年龄、种族、心血管危险因素和药物使用等潜在混杂因素后，SLE女性与无SLE女性相比发生心血管事件的RR为2.26（95%置信区间[95%CI]1.45 - 3.52）。当分别分析终点时，冠心病的RR为2.25（95%CI 1.37 - 3.69），中风的RR为2.29（95%CI 0.85 - 6.15）。
在这项基于人群的前瞻性研究中，我们发现SLE患者心血管疾病风险在统计学上显著增加了2倍以上。该风险不如先前报道的高，这可能是由于该队列中SLE诊断时年龄相对较大。
