Premature Cardiovascular Disease in Women with Lupus and Relationship to Disease Severity
J. Patricia Dhar, Phillip Levy, Lynnette Essenmacher, Joel Ager, Lisa Chiodo, Daniel Schultz, Azadeh Stark, Ann Schwartz and Robert J. Sokol
Affiliation: University Health Center, 4H- 32, 4201 St Antoine, Detroit, MI 48201, USA.
Introduction: Premature onset of cardiovascular disease (CVD) in women with systemic lupus erythematosus
(SLE) seems to involve both traditional Framingham risk factors as well as lupus-specific factors. We assessed the risk of
cardiovascular disease in premenopausal women with lupus and any relationship of cardiovascular disease to disease
severity and history of pregnancy hypertensive complications.
Methods: Female patients in this study with a confirmed diagnosis of lupus were obtained from the Wayne State
University Database. We used chi-square analysis to assess the effect of 2 suspected risk factors (lupus disease severity
and hypertensive complications during pregnancy [i.e., eclampsia/pre-eclampsia]) on cardiovascular (myocardial
infarction [MI], transient ischemic attack [TIA], and chronic hypertension [HTN]) and metabolic (hyperlipidemia [HL]
and diabetes mellitus [DM]) disease rates. To quantify the degree of excess risk in SLE patients, we used a Z test for
proportions with population frequencies from the National Health and Nutrition Examination Survey (NHANES) database
as the comparator and calculated risk ratios (RR) for specific cardiovascular and metabolic diseases among pre- and postmenopausal
women [29, 30].
Results: Mean age of the cohort was 33 years at time of lupus diagnosis, 343 (50.6%) were premenopausal, 310 (45.8%)
had severe SLE, and 25 (3.7%) had pregnancy hypertensive complications. Chi Square analysis showed statistically
significant increases in both cardiovascular and metabolic diseases in women with severe SLE. Among those with
hypertensive complications during pregnancy, the only significant association was the development of chronic HTN
(p<0.01). For cardiovascular risk, we focused on the 343 premenopausal women. Premenopausal women with SLE were
at significantly increased risk for myocardial infarction [MI] (RR=5.50), hypertension [HTN] (RR=1.22), transient
ischemic attacks [TIA] (RR=4.38), and hyperlipidemia (RR=1.9).
Conclusion: Women with SLE are at increased risk for premature cardiovascular disease compared to the general
population. Increased risk for cardiovascular disease appears greatest for women with severe lupus indicating a potential
dose/response relationship. Premenopausal women with severe SLE should be monitored closely for cardiovascular
Keywords: Cardiovascular disease, lupus, myocardial infarction, SLE, systemic lupus erythematosus.
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