Internal Medicine Department, Division of Rheumatology, University of Kentucky, Lexington, Kentucky, USA.
Department of Statistics, University of Kentucky, Lexington, Kentucky, USA.
Lupus Sci Med. 2021 May;8(1). doi: 10.1136/lupus-2020-000467.
Cardiovascular complications became a notable cause of morbidity and mortality in patients with lupus as therapeutic advancements became more efficient at managing other complications. The Appalachian community in Kentucky has a higher prevalence of traditional cardiovascular risk factors, predisposing them to cardiovascular events. Namely, the mean body mass index of the members of the Kentucky Appalachian community was reported at 33 kg/m and 94.3% of male members of this community use tobacco. We sought to identify risk factors that predispose patients with lupus to cardiovascular morbidities and examine the effect of immunomodulatory drugs.
We identified 20 UKHS patients having both a lupus diagnosis and experienced at least one cardiovascular event. We chose three controls matched for birth-year ±5 years to each case. In a case-control design, we analysed lupus manifestations, cardiovascular risk factors and immunosuppressive therapies. We collected Systemic Lupus Erythematosus Disease Activity Index 2000 disease activity index during the cardiovascular event.
We identified 308 patients with lupus from among all University of Kentucky Health System patients. 20 (6.5%) of such patients with lupus were confirmed to cardiovascular complication. Of those 20, 7 (35%) had experienced myocardial infarction, 10 (50%) had experienced stroke and 4 (20%) had peripheral ischaemia. Tobacco use and male gender were the only traditional cardiovascular risk factors higher in the cases group. Hydroxychloroquine and steroids were less utilised in the cases than in the controls (70% vs 100% in hydroxychloroquine, 30% vs 82% in steroids). Venous thrombosis was found to be significantly higher in the cases. On multivariate analysis, venous thrombosis remained significant.
Despite tobacco use partially explaining the increased risk of cardiovascular disease among the cases group, the higher prevalence of venous thrombosis in the cases group suggests lupus as a potential additional risk factor of cardiovascular morbidity among patients with lupus in this Appalachian community.
随着治疗方法的进步，能够更有效地治疗其他并发症，心血管并发症已成为狼疮患者发病率和死亡率的一个重要原因。肯塔基州阿巴拉契亚社区的传统心血管危险因素更为普遍，使他们易患心血管事件。具体来说，该社区成员的平均体重指数为 33kg/m，该社区 94.3%的男性成员使用烟草。我们试图确定使狼疮患者易患心血管疾病的危险因素，并检查免疫调节药物的效果。
我们确定了 20 名 UKHS 患者，他们既有狼疮诊断，又经历过至少一次心血管事件。我们选择了三个与每个病例出生年份相差±5 年的对照组。在病例对照设计中，我们分析了狼疮表现、心血管危险因素和免疫抑制治疗。我们收集了心血管事件期间的系统性红斑狼疮疾病活动指数 2000 疾病活动指数。
我们从肯塔基大学健康系统的所有狼疮患者中确定了 308 名狼疮患者。其中 20 名狼疮患者被证实患有心血管并发症。在这 20 名患者中，7 名（35%）经历了心肌梗死，10 名（50%）经历了中风，4 名（20%）经历了外周缺血。烟草使用和男性是病例组中仅有的更高的传统心血管危险因素。羟氯喹和类固醇在病例组中的使用率低于对照组（羟氯喹组为 70%对 100%，类固醇组为 30%对 82%）。血栓形成在病例组中明显更高。多变量分析显示，血栓形成仍然具有显著意义。
尽管烟草使用部分解释了病例组心血管疾病风险增加，但病例组中静脉血栓形成的更高发生率表明，在阿巴拉契亚社区的狼疮患者中，狼疮可能是心血管发病率的另一个潜在危险因素。
