Premature Coronary-Artery Atherosclerosis in Systemic Lupus Erythematosus
Yu Asanuma, M.D., Ph.D., Annette Oeser, B.S., Ayumi K. Shintani, Ph.D., M.P.H., Elizabeth Turner, M.D., Nancy Olsen, M.D., Sergio Fazio, M.D., Ph.D., MacRae F. Linton, M.D., Paolo Raggi, M.D., and C. Michael Stein, M.D.
Background Premature coronary artery disease is a major causeof illness and death in patients with systemic lupus erythematosus,but little is known about the prevalence, extent, and causesof coronary-artery atherosclerosis.
Methods We used electron-beam computed tomography to screenfor the presence of coronary-artery calcification in 65 patientswith systemic lupus erythematosus (mean [±SD] age, 40.3±11.6years) and 69 control subjects (mean age, 42.7±12.6 years)with no history of coronary artery disease. When calcificationwas detected, the extent was measured by means of the Agatstonscore. The frequency of risk factors for coronary artery diseasewas compared in patients and controls, and the relation betweenthe patients' clinical characteristics and the presence or absenceof coronary-artery calcification was examined.
Results The two groups were similar with respect to age, race,and sex. Coronary-artery calcification was more frequent inpatients with lupus (20 of 65 patients) than in control subjects(6 of 69 subjects) (P=0.002). The mean calcification score was68.9±244.2 in the patients and 8.8±41.8 (P<0.001)in controls. Levels of total, high-density lipoprotein, andlow-density lipoprotein cholesterol were not elevated in patientswith lupus, but levels of triglycerides (P=0.02) and homocysteine(P<0.001) were. Among patients with lupus, measures of diseaseactivity were similar in those with and those without coronary-arterycalcification, but those with calcification were more likelyto be older (P<0.001) and male (P=0.008).
Conclusions In patients with systemic lupus erythematosus, theprevalence of coronary-artery atherosclerosis is elevated andthe age at onset is reduced. Early detection of atherosclerosismay provide an opportunity for therapeutic intervention.
Source Information
From the Divisions of Clinical Pharmacology (Y.A., A.O., C.M.S.), General Internal Medicine (A.K.S.), Rheumatology (E.T., N.O., C.M.S.), and Cardiovascular Medicine (S.F., M.F.L.), Vanderbilt University School of Medicine, Nashville; and the Section of Cardiology, Tulane University School of Medicine, New Orleans (P.R.).
Premature Coronary Disease in Systemic Lupus
Wurzel J., Goldman B. I., Doria A., Shoenfeld Y., Pauletto P., Violi F., Loffredo L., Ferro D., Pezzetta F., Mascitelli L., Noël B., Roman M. J., Lockshin M. D., Salmon J. E., Stein C. M., Hahn B. H.
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N Engl J Med 2004;
350:1571-1575, Apr 8, 2004.
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