Vascular events in hypertensive patients with systemic lupus erythematosus

BackgroundThe 2017 American College of Cardiology/American Heart Association guidelines defined hypertension at ≥130/80 mm Hg. Studies on patients with connective tissue diseases were not considered. Our aim was to assess the impact of this definition on atherosclerotic vascular events (AVEs) in systemic lupus erythematosus.Patients methodsIndividuals from the Toronto Lupus Clinic with at least 2 years of follow-up and no prior AVE were divided in three groups according to their mean blood pressure (BP) over that period (≥140/90 mm Hg, 130-139/80-89 mm Hg and <130/80 mm Hg). They were followed until the first occurrence of an AVE (fatal or non-fatal coronary artery disease, cerebrovascular event and peripheral vascular disease) or last visit. Groups were compared as per the baseline atherosclerotic risk factors. A multivariable time-dependent analysis was performed to adjust for the presence of other risk factors.ResultsOf 1532 patients satisfying the inclusion criteria, 155 (10.1%) had a BP ≥140/90 mm Hg, 316 (20.6%) 130–139/80–89 mm Hg and 1061 (69.3%) were normotensives. After a mean follow-up of 10.8 years, 124 AVEs were documented. The incidence rates were 18.9, 11.5 and 4.5 per 1000 patient-years for the three groups, respectively (p=0.0007 between the 130–139/80–89 mm Hg group and the normotensives). A mean BP of 130–139/80–89 mm Hg over the first 2 years was independently associated with the occurrence of AVEs (HR 1.73, 95% CI 1.13 to 2.65, p=0.011).ConclusionPatients with lupus with a sustained mean BP of 130–139/80–89 mm Hg over 2 years had a significantly higher incidence of AVEs compared with normotensive individuals. This BP level should be the target for antihypertensive therapy to minimise their cardiovascular risk.

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Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort

Arthritis & Rheumatology ◽

10.1002/art.41392 ◽

2020 ◽

Vol 72 (10) ◽

pp. 1734-1740 ◽

Cited By ~ 1

Author(s):

Murray B. Urowitz ◽

Dafna D. Gladman ◽

Vernon Farewell ◽

Jiandong Su ◽

Juanita Romero-Diaz ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Vascular Events

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O30 Complement deposition, C4d, on platelets is associated with vascular events and antiphospholipid antibodies in systemic lupus erythematosus

10.1136/lupus-2020-eurolupus.41 ◽

2020 ◽

Author(s):

Elisabet Svenungsson ◽

Johanna T Gustafsson ◽

Giorgia Grosso ◽

Marios Rossides ◽

Iva Gunnarsson ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Antiphospholipid Antibodies ◽

Systemic Lupus ◽

Vascular Events ◽

Complement Deposition

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Functional Polymorphisms of the Coagulation Factor II Gene (F2) and Susceptibility to Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.100728 ◽

2011 ◽

Vol 38 (4) ◽

pp. 652-657 ◽

Cited By ~ 7

Author(s):

F. YESIM K. DEMIRCI ◽

AMY S. DRESSEN ◽

CANDACE M. KAMMERER ◽

M. MICHAEL BARMADA ◽

AMY H. KAO ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

African Americans ◽

Allele Frequency ◽

Lupus Erythematosus ◽

Coagulation Factor ◽

Systemic Lupus ◽

Vascular Events ◽

Functional Polymorphisms ◽

Caucasian Americans ◽

Activity Measurements

Objective.TwoF2functional polymorphisms, rs1799963 (G20210A) and rs3136516 (A19911G), are known to be associated with elevated levels/activity of prothrombin (encoded byF2) and risk of thrombosis. Since patients with systemic lupus erythematosus (SLE) have high risk of thrombosis and accelerated atherosclerosis and also high prevalence of anti-prothrombin antibodies, we hypothesized that these twoF2polymorphisms could affect risk of SLE.Methods.We investigated these polymorphisms in 627 women with SLE (84% Caucasian Americans, 16% African Americans) and 657 female controls (78% Caucasian Americans, 22% African Americans).Results.While the rs1799963 A allele was almost absent in African Americans, it was present at ∼2% frequency in Caucasian Americans and showed no significant association with SLE. The rs3136516 G allele frequency was significantly higher in Caucasian SLE cases than in controls (48.4% vs 43.7%, respectively) with a covariate-adjusted odds ratio (OR) of 1.22 (95% CI 1.03–1.46, p = 0.023). The association was replicated in African Americans (rs3136516 G allele frequency 91.2% in cases vs 82.2% in controls) with an adjusted OR of 1.96 (95% CI 1.08–3.58, p = 0.022). Stratification of Caucasian SLE patients based on the presence or absence of cardiac and vascular events (CVE) revealed stronger association with the CVE-positive SLE subgroup than the CVE-negative SLE subgroup (OR 1.42 vs 1.20). Prothrombin activity measurements in a subset of SLE cases demonstrated higher activity in the carriers of the rs3136516 G allele.Conclusion.Our results suggest a potential role for prothrombin and the crosstalk between hemostatic and immune/inflammatory systems in SLE and SLE-associated cardiovascular events, which warrants further investigation in independent samples.

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