WASHINGTON — Awareness of the increased risk of atherosclerosis in patients who have lupus may be rising, but even experts in lupus treatment are not adequately treating patients who have known risk factors for the condition, Dr. Murray B. Urowitz reported at the annual meeting of the American College of Rheumatology.
Premature atherosclerosis in patients with systemic lupus erythematosus (SLE) may develop as a result of a combination of disease- and therapy-related factors, classic coronary artery disease risk factors, and genetic factors. Many of these factors are present within the first year after diagnosis of SLE, said Dr. Urowitz, director of the Centre of Prognosis Studies in the Rheumatic Diseases at Toronto Western Hospital.
He and his colleagues in the Systemic Lupus International Collaborating Clinics (SLICC), a group of 30 investigators located at 27 centers around the world, conducted an analysis of 935 SLE patients who had been enrolled in the multicenter registry within 15 months of diagnosis during 2000–2006.
Follow-up data at 3 years were available for 278 patients. These patients had a mean SLE disease activity index-2k (SLEDAI-2k) score of 5.49 at enrollment and an adjusted mean SLEDAI-2k over 3 years of 4.94.
Of 101 patients who had hypercholesterolemia at enrollment, 25 received treatment for the condition. After 3 years, 167 patients had ever had hypercholesterolemia, but only 63 (38%) had received treatment.
“For some unknown reason … there is some reluctance to begin therapy with cholesterol-lowering medications in our patients,” Dr. Urowitz said at the meeting.
“We can no longer say that we are busy looking at the initial treatment of patients with lupus. This is now 3 years into the illness,” he said. These findings are coming from “the 'august' SLICC group who call themselves 'lupologists.'”
In comparison, the percentage of hypertensive patients who received treatment increased from enrollment (87 of 109 [80%]) to the 3-year follow-up (144 of 162 [89%]) even though the prevalence of hypertension increased.
Other risk factors for coronary artery disease increased in prevalence during the 3 years, including the percentage of patients who currently or had ever smoked (from 14% to 19% and from 37% to 42%, respectively), the percentage of patients who reported a family history of coronary artery disease (from 18% to 25%), as well as the percentage of those with diabetes mellitus or who had become postmenopausal.
Risk factors relating to body composition also increased during follow-up, such as the percentage of patients with a body mass index in the overweight or obese range (from 31% to 46%), a waist-to-hip ratio greater than 0.8 (from 32% to 55%), and low physical activity (from 37% to 55%). Since enrollment, more of the patients had taken corticosteroids (from 71% to 79%), antimalarials (from 60% to 77%), or immunosuppressives (from 38% to 59%).
“All risk factors increased in prevalence over 3 years, so you're not off the hook when they start [treatment]; this doesn't tell the whole story. You must continue to follow up patients,” said Dr. Urowitz, professor of medicine at the University of Toronto.