Clinical Characteristics and Prognosis of Patients With Antiphospholipid Antibodies Based on Cluster Analysis: An 8-Year Cohort Study

2021 ◽  
Author(s):  
Wanting Qi ◽  
Jiuliang Zhao ◽  
Can Huang ◽  
Nan Jiang ◽  
Jing Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cluster Analysis ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Bleeding Events ◽  
College Hospital ◽  
Cluster 2

Abstract Background: Antiphospholipid syndrome (APS) is an autoimmune disease characterized by persistent antiphospholipid antibodies (aPLs) positivity with a wide manifestation spectrum. A risk stratification is needed for management guidance and prognosis assessment. We aimed to identify phenotypes among aPL-positive patients and assess the prognosis of each phenotype.Methods: This was a single-center, prospective cohort study of aPL-positive patients presented to Peking Union Medical College Hospital from 2012 to 2020. Demographic characteristics, aPL-related manifestations, cardiovascular risk factors and antibodies profiles were recorded. The primary endpoint was defined as a combination of newly-onset thrombosis, major bleeding events, non-criteria manifestations and all-cause death. Hierarchical cluster analysis and Kaplan-Meier survival analysis were performed.Results: Four clusters among 383 patients (70.2% female; mean age 37.7 years) were identified. Cluster 1 (n=138): patients with systemic lupus erythematosus (SLE) and non-criteria manifestations; Cluster 2 (n=112): patients with multiple cardiovascular risk factors; Cluster 3 (n=83): female patients with obstetric morbidity; Cluster 4 (n=50): patients with isolated lupus anticoagulant (LA) positivity.Non-criteria manifestations were found aggregated with SLE from cluster analysis of variables. Cluster 3 showed the best outcome, while cluster 2 suffered highest frenquency of newly-onset arterial thrombosis.Conclusions: We identified 4 clinical phenotypes of aPL-positive patients. Non-criteria manifestations may indicate underlying SLE, for which immunosuppressive therapy besides anticoagulation may be necessary. Patients with isolated LA positivity suffered similar risks with secondary APS and patients with multiple cardiovascular risk factors. Attention should be paid to male patients, and the screening of cardiovascular risk factors should never be ignored.

scholarly journals OP0290 CLINICAL CHARACTERISTICS AND PROGNOSIS OF ANTIPHOSPHOLIPID SYNDROME PATIENTS BASED ON CLUSTER ANALYSIS: A 10-YEAR COHORT STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 178.1-178
Author(s):  
W. Qi ◽  
J. L. Zhao ◽  
X. Tian ◽  
M. LI ◽  
X. Zeng
Keyword(s):  
Risk Factors ◽  
Cluster Analysis ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Antiphospholipid Syndrome ◽  
Smoking History ◽  
Pregnancy Morbidity ◽  
Kaplan Meier ◽  
Male Patients

Background:APS is an autoimmune disease characterized by persistent antiphospholipid antibodies (aPLs) positivity, leading to thrombotic events or pregnancy morbidity. High-risk aPLs profiles included positive lupus anticoagulant (LA) and multiple aPLs positivity1. Association was also found between aPLs and a variety of manifestations beyond thrombosis, referred to “non-criteria manifestations” (i.e. thrombocytopenia, hemolytic anemia, heart valve disease and aPL-related nephropathy)2, of which the role in APS risk stratification is poorly understood. The manifestation spectrum of APS is wide, ranging from asymptomatic aPLs positivity to life-threatening catastrophic APS, and patients other than confirmed APS also need proper management. Therefore, a risk stratification integrating demographic data, aPL-related manifestations, aPLs profiles, coexisting cardiovascular risk factors and SLE is needed for management guidance and prognosis assessment.Objectives:Using cluster analysis, to identify phenotypes among aPL-positive patients and assess the prognosis of each phenotype.Methods:This is a single-center, prospective cohort study of aPL-positive patients who presented to Peking Union Medical College Hospital from 2004 to 2020. Demographic characteristics, aPL-related manifestations, cardiovascular risk factors, antibodies profile and follow-up data were recorded. The primary end point was defined as a combination of newly onset arterial thrombosis (AT) or deep venous thrombosis (DVT), major bleeding events, non-criteria manifestations and all-cause death. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of patients and variables separately. Multiple comparison and Kaplan-Meier survival analysis were performed among clusters.Results:Four clusters among 383 patients (70.2% female; mean age 37.7 years) were identified (Figure 1A). Cluster 1 (n=138): female patients with SLE, non-criteria manifestations, triple aPLs positivity, high AT rate and moderate DVT rate. Cluster 2 (n=112): male patients with obesity, smoking history, hypertension, hyperhomocysteinemia, triple aPLs positivity and the highest rate of AT and DVT. Cluster 3 (n=83): female patients with the highest pregnancy morbidity rate and the lowest thrombosis rate. Cluster 4 (n=50): 62% male patients with isolated LA positivity, high AT rate and moderate DVT rate. Four clusters of variables were also identified (Figure 1A). From Kaplan-Meier survival analysis, 1-, 5- and 10-year event-free survival rates were 92.6%, 79.8% and 66.8%, respectively. Cluster 3 showed lowest incidence of primary endpoint (Figure 1B), while Cluster 1 and 2 showed higher newly-onset AT risk compared with other clusters (P=0.028 for 2 vs 3 and P=0.049 for 2 vs 4).Figure 1.Conclusion:We identified 4 clinical phenotypes of aPL-positive patients. APS secondary to SLE was always aggregated with non-criteria manifestations. Clinicians should be alert to the possibility of SLE in aPL-positive patients with coexisting non-criteria manifestations, for whom immunosuppressive therapy besides anticoagulation may be necessary. Cluster 4 represented patients with isolated LA positivity and shared similar prognosis with secondary APS and male patients, which confirmed that LA represented a high-risk antibody spectrum. Additionally, cardiovascular risk factors (i.e. male, smoking history and obesity) played an important role in thrombosis events, and led to poor prognosis. Therefore, more attention should be paid to male patients, and the screening and management of cardiovascular risk factors should not be ignored.References:[1]Tektonidou MG, Andreoli L, Limper M et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019;78:1296–304.[2]Miyakis S, Lockshin MD, Atsumi T et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306.Disclosure of Interests:None declared.

scholarly journals Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

2012 ◽  
Vol 39 (12) ◽  
pp. 2286-2293 ◽  
Author(s):  
ADNAN N. KIANI ◽  
JENS VOGEL-CLAUSSEN ◽  
ARMIN ARBAB-ZADEH ◽  
LAURENCE S. MAGDER ◽  
JOAO LIMA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Lupus Erythematosus ◽  
Univariate Analysis ◽  
Coronary Plaque ◽  
Systemic Lupus ◽  
History Of ◽  
Noncalcified Plaque

Objective.A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE.Methods.Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.Results.The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant.Conclusion.Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.

scholarly journals Gender Inequalities in Diagnostic Inertia around the Three Most Prevalent Cardiovascular Risk Studies: Protocol for a Population-Based Cohort Study

2021 ◽  
Vol 18 (8) ◽  
pp. 4054
Author(s):  
Concepción Carratala-Munuera ◽  
Adriana Lopez-Pineda ◽  
Domingo Orozco-Beltran ◽  
Jose A. Quesada ◽  
Jose L. Alfonso-Sanchez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Disease Incidence ◽  
Population Based ◽  
Gender Inequalities ◽  
Primary Health Care Centers

Evidence shows that objectives for detecting and controlling cardiovascular risk factors are not being effectively met, and moreover, outcomes differ between men and women. This study will assess the gender-related differences in diagnostic inertia around the three most prevalent cardiovascular risk factors: dyslipidemia, arterial hypertension, and diabetes mellitus, and to evaluate the consequences on cardiovascular disease incidence. This is an epidemiological and cohort study. Eligible patients will be adults who presented to public primary health care centers in a Spanish region from 2008 to 2011, with hypertension, dyslipidemia, or/and diabetes and without cardiovascular disease. Participants’ electronic health records will be used to collect the study variables in a window of six months from inclusion. Diagnostic inertia of hypertension, dyslipidemia, and/or diabetes is defined as the registry of abnormal diagnostic parameters—but no diagnosis—on the person’s health record. The cohort will be followed from the date of inclusion until the end of 2019. Outcomes will be cardiovascular events, defined as hospital admission due to ischemic cardiopathy, stroke, and death from any cause. The results of this study could inform actions to rectify the structure, organization and training of health care teams in order to correct the inequality.

scholarly journals O3-08-02: CARDIOVASCULAR RISK FACTORS ACROSS THE LIFECOURSE AND COGNITIVE DECLINE: A POOLED COHORT STUDY

2019 ◽  
Vol 15 ◽  
pp. P901-P901
Author(s):  
Kristine Yaffe ◽  
Eric Vittinghoff ◽  
Patrick Stuchlik ◽  
Leslie Grasset ◽  
Tina D. Hoang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cognitive Decline ◽  
Cardiovascular Risk Factors

scholarly journals Prepregnancy Cardiovascular Risk Factors as Predictors of Preeclampsia: Population-based Cohort Study

2008 ◽  
Vol 28 (2) ◽  
pp. 79 ◽  
Author(s):  
E.B. Magnussen ◽  
L.J. Vatten ◽  
T.I. Lund-Nilsen ◽  
K.A. Salvesen ◽  
G. Davey Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Population Based

scholarly journals Contribution of cardiovascular risk factors to coronary risk in patients with intermittent claudication in the PRIME Cohort Study of European men

2009 ◽  
Vol 206 (2) ◽  
pp. 563-568 ◽  
Author(s):  
Emmanuelle Tilloy ◽  
Michèle Montaye ◽  
Frank Kee ◽  
Annie Bingham ◽  
Dominique Arveiler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Intermittent Claudication ◽  
Coronary Risk

scholarly journals Egocentric Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study

2019 ◽  
Vol 35 (3) ◽  
pp. 784-791
Author(s):  
Carol R. Oladele ◽  
Terri-Ann Thompson ◽  
Karen Wang ◽  
Deron Galusha ◽  
Emma Tran ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Health Networks

P1532Asymptomatic structural heart disease in individuals without apparent cardiovascular risk factors An unnoticed potential precursor stage of heart failure. Results from the STAAB cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Morbach ◽  
G Gelbrich ◽  
T Tiffe ◽  
F Eichner ◽  
M Breunig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Risk Factor ◽  
Cohort Study ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Structural Heart Disease ◽  
Qtc Interval ◽  
Lv Ejection Fraction

Abstract Background and aim Prevention of heart failure (HF) relies on early identification and elimination of cardiovascular risk factors. ACC/AHA guidelines define consecutive asymptomatic precursor stages of HF, i.e. stage A (with risk factors for HF), and stage B (asymptomatic cardiac dysfunction). We aimed to identify frequency and characteristics of individuals at risk for HF, i.e. stage A and B, in the general population. Methods The prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study phenotyped a representative sample of 5000 residents (aged 30–79 y) of a medium sized German town, reporting no previous HF diagnosis. Echocardiography was highly quality-controlled. We applied these definitions: HF stage A: ≥1 risk factor for HF (hypertension, arteriosclerotic disease, diabetes mellitus, obesity, metabolic syndrome), but no structural heart disease (SHD); HF stage B: asymptomatic but SHD [reduced left ventricular (LV) ejection fraction, LV hypertrophy, LV dilation, stenosis or grade 2/3 regurgitation of aortic/mitral valve, grade 2/3 diastolic dysfunction], or prior myocardial infarction; Normal (N): no risk factor and no SHD. We focused on subjects in stage B without apparent cardiovascular risk factors qualifying for A (B-not-A) compared to those with risk factors (BA) and N. The first half of the sample (n=2473) served as derivation set (D), the second half (n=2434) as validation set (V). Results We found 42% (D)/45% (V) of subjects in stage A, and 18% (D)/17% (V) in stage B. Among stage B subjects, 31% (D)/29% (V) were B-not-A. Compared to BA, B-not-A subjects were younger [47 vs. 63 y (D)/50 vs 63 years (V); both p<0.001] and more often female [78% vs 56% (D)/79% vs 62% (V); both p<0.001], had higher LV ejection fraction [59% vs 56% (D)/53% vs 48% (V); both p<0.05], lower E/e' [6.7 vs 9.9 (D)/6.9 vs. 9.3 (V); both p<0.001], higher LV volume [64 vs 59 mL/m2 (D)/54 vs 48 mL/m2 (V); both p≤0.01], lower hemoglobin [13.3 vs 13.9 g/dL (D, p=0.02)/13.4 vs 13.8 g/dL (V, p=0.08); both adjusted for sex], and lower QTc interval [423 vs 433 ms (D)/427 vs 438 ms (V); both p≤0.001). Compared to N, subjects in B-not-A were more often female [78% vs 56% (D)/79% vs 61% (V); both p<0.001], had larger QTc interval [423 vs 418 ms (D)/427 vs 420 ms (V); both p<0.05], and more often anemia [11% vs 5% (D, p=0.02)/9% vs 5% (V, p=0.12)]. Conclusions We confirmed, by extensive internal validation, the presence of a hitherto undescribed group of individuals with relevant myocardial alterations, but lacking respective risk factors. Since algorithms in primary prevention do not include echocardiography, this subgroup might be missed. Further investigations should 1) externally validate our finding, 2) study the prognostic course of subjects in group B-not-A, and 3) elaborate the material differences between B-not-A and N to identify potential further novel risk factors for HF. Acknowledgement/Funding German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg (BMBF 01EO1004 and 01EO1504)

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