Duke University Medical Center, Durham, NC 27710, USA.
Arthritis Care Res (Hoboken). 2013 Feb;65(2):266-73. doi: 10.1002/acr.21782.
To determine if systemic lupus erythematosus (SLE) is associated with a higher prevalence of coronary artery disease (CAD) in select patients undergoing coronary angiography. We compared the extent of angiographic abnormalities, CAD risk factors, and all-cause mortality in SLE patients with non-SLE controls.
We identified SLE patients (n = 86) and controls matched by sex and year of cardiac catheterization (n = 258) undergoing cardiac catheterization for the evaluation of CAD (median followup duration of 4.3 years). Multivariable logistic regression was used to determine if SLE was associated with obstructive CAD, defined as ≥70% stenosis in a major epicardial coronary artery. Risk-adjusted survival differences between the 2 groups were assessed using Cox proportional hazards modeling.
The SLE patients (85% women) were younger than the non-SLE patients (median age 49 years versus 70 years; P < 0.001) and were less likely to have diabetes mellitus and hyperlipidemia, but had similar rates of hypertension (70% versus 71%; P = 0.892). In unadjusted analyses, SLE and non-SLE patients had similar rates of obstructive CAD by angiography (52% versus 62%; overall P = 0.11). After adjustment for known CAD risk factors, SLE was associated with a significantly increased likelihood of CAD (odds ratio 2.24 [95% confidence interval (95% CI) 1.08-4.67]). SLE was also associated with a nonsignificant increase in all-cause mortality (hazard ratio 1.683 [95% CI 0.98-2.89], P = 0.060).
In this selected population, SLE was significantly associated with the presence of CAD as defined by coronary angiography, the gold standard for assessing flow-limiting lesions in this disease. The patients with SLE showed a similar severity of CAD as the controls despite having less than half the rate of diabetes mellitus and being 20 years younger.
确定系统性红斑狼疮（SLE）是否与接受冠状动脉造影检查的特定患者中冠状动脉疾病（CAD）的患病率较高相关。我们比较了 SLE 患者和非 SLE 对照者的血管造影异常程度、CAD 危险因素和全因死亡率。
我们确定了 SLE 患者（n=86）和按性别和心脏导管插入术年份匹配的非 SLE 对照者（n=258），这些患者因 CAD 接受心脏导管插入术检查（中位随访时间为 4.3 年）。采用多变量逻辑回归来确定 SLE 是否与阻塞性 CAD 相关，阻塞性 CAD 定义为主要心外膜冠状动脉≥70%狭窄。使用 Cox 比例风险模型评估两组之间风险调整后生存差异。
SLE 患者（85%为女性）比非 SLE 患者年轻（中位年龄 49 岁比 70 岁；P＜0.001），且糖尿病和高脂血症发生率较低，但高血压发生率相似（70%比 71%；P=0.892）。在未经调整的分析中，SLE 和非 SLE 患者的血管造影阻塞性 CAD 发生率相似（52%比 62%；总体 P=0.11）。在调整了已知 CAD 危险因素后，SLE 与 CAD 的发生显著相关（优势比 2.24[95%置信区间（95%CI）为 1.08-4.67]）。SLE 也与全因死亡率的非显著增加相关（风险比 1.683[95%CI 为 0.98-2.89]，P=0.060）。
在这个选择的人群中，SLE 与冠状动脉造影定义的 CAD 显著相关，冠状动脉造影是评估该疾病中限制血流病变的金标准。尽管 SLE 患者的糖尿病患病率不到一半，且比对照组年轻 20 岁，但他们的 CAD 严重程度与对照组相似。
