Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Arthritis Res Ther. 2012;14(2):R46. doi: 10.1186/ar3759.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Cardiovascular disease (CVD) is common and a major cause of mortality. Studies on cardiovascular morbidity are abundant, whereas mortality studies focusing on cardiovascular outcomes are scarce. The aim of this study was to investigate causes of death and baseline predictors of overall (OM), non-vascular (N-VM), and specifically cardiovascular (CVM) mortality in SLE, and to evaluate systematic coronary risk evaluation (SCORE).
208 SLE patients were included 1995-1999 and followed up after 12 years. Clinical evaluation, CVD risk factors, and biomarkers were recorded at inclusion. Death certificates and autopsy protocols were collected. Causes of death were divided into CVM (ischemic vascular and general atherosclerotic diseases), N-VM and death due to pulmonary hypertension. Predictors of mortality were investigated using multivariable Cox regression. SCORE and standardized mortality ratio (SMR) were calculated.
During follow-up 42 patients died at mean age of 62 years. SMR 2.4 (CI 1.7-3.0). 48% of deaths were caused by CVM. SCORE underestimated CVM but not to a significant level. Age, high cystatin C levels and established arterial disease were the strongest predictors for all- cause mortality. After adjusting for these in multivariable analyses, only smoking among traditional risk factors, and high soluble vascular cell adhesion molecule-1 (sVCAM-1), high sensitivity C-reactive protein (hsCRP), anti-beta2 glycoprotein-1 (abeta2GP1) and any antiphospholipid antibody (aPL) among biomarkers, remained predictive of CVM.
With the exception of smoking, traditional risk factors do not capture the main underlying risk factors for CVM in SLE. Rather, cystatin C levels, inflammatory and endothelial markers, and antiphospholipid antibodies (aPL) differentiate patients with favorable versus severe cardiovascular prognosis. Our results suggest that these new biomarkers are useful in evaluating the future risk of cardiovascular mortality in SLE patients.
系统性红斑狼疮（SLE）是一种慢性自身免疫性疾病。心血管疾病（CVD）很常见，也是主要的死亡原因。关于心血管发病率的研究很多，而关注心血管结局的死亡率研究却很少。本研究旨在探讨SLE 患者的死亡原因和全因（OM）、非血管性（N-VM）和特定心血管（CVM）死亡率的基线预测因素，并评估系统性冠状动脉风险评估（SCORE）。
纳入 208 例 1995-1999 年的 SLE 患者，随访 12 年后。在纳入时记录临床评估、CVD 危险因素和生物标志物。收集死亡证明和尸检方案。将死亡原因分为 CVM（缺血性血管和一般动脉粥样硬化疾病）、N-VM 和肺动脉高压导致的死亡。使用多变量 Cox 回归分析死亡率的预测因素。计算 SCORE 和标准化死亡率比（SMR）。
随访期间，42 名患者平均年龄 62 岁死亡。SMR 2.4（CI 1.7-3.0）。48%的死亡是由 CVM 引起的。SCORE 低估了 CVM，但没有达到显著水平。年龄、高胱抑素 C 水平和已确立的动脉疾病是全因死亡的最强预测因素。在多变量分析中调整这些因素后，只有传统危险因素中的吸烟，以及生物标志物中的高可溶性血管细胞黏附分子-1（sVCAM-1）、高敏 C 反应蛋白（hsCRP）、抗β2 糖蛋白-1（abeta2GP1）和任何抗磷脂抗体（aPL），仍然预测 CVM。
除了吸烟外，传统危险因素并不能捕捉到 SLE 患者 CVM 的主要潜在危险因素。相反，胱抑素 C 水平、炎症和内皮标志物以及抗磷脂抗体（aPL）区分了具有良好和严重心血管预后的患者。我们的结果表明，这些新的生物标志物可用于评估 SLE 患者未来心血管死亡率的风险。
