Women with systemic lupus erythematosus (SLE) are at increased risk for coronary artery disease (CAD) and mortality. The dominant risk factors are SLE itself, age, and high total triglyceride levels rather than the traditional Framingham risk factors.
Goldberg and associates evaluated a group from the Toronto Risk Factor Study for 7 to 9 years. Study participants—241 patients with SLE and 237 controls—were monitored for evidence of CAD. Cardiovascular and lupus-specific risk factors that could influence the onset of CAD were examined.
CAD occurred in 7.1% of the women with SLE and 2.1% of the controls. Body mass index and incidence of metabolic syndrome were similar in the 2 groups, as was the 10-year risk calculation for coronary disease. Among all women, CAD was positively linked with age and postmenopausal status. CAD was predicted by sedentary lifestyle, hypertension, metabolic syndrome, and a triglyceride level of 2.8 mmol/L or higher in controls but not in patients with SLE; none of the lipid subfractions predicted CAD in the latter group.
The authors noted that their findings emphasize the need to identify measurable lupus-related factors that accelerate atherosclerosis in SLE and to determine prospectively the value of screening for subclinical atherosclerotic disease.