Vascular Events in Systemic Lupus Erythematosus: Why Should Gender or Pleural Disease Matter?

In a concurrent abstract oral presentation today by Murray Urowitz (Abstract #1065), representing the SLICC cohort (Systemic Lupus Erythematosus International Collaborating Clinics), predictors of vascular events in this prospective cohort were discussed. Out of 1848 patients entering the cohort over the last 15 years, 73 vascular events attributed to atherosclerosis were identified. Patients with vascular events were more often male, Caucasian, older, smokers, hypertensive, diabetic, hypercholesterolemic and had a positive family history of coronary artery disease.

Interestingly, a signal reflecting the specific manifestation of pleuritis was seen in two different analyses. In a multivariate analysis, male gender, age at diagnosis of SLE, and the presence of the ACR criteria of serositis, were predictive of vascular events. This was further confirmed by an evaluation of disease activity at the time of clinical presentation. Disease activity manifestation on the SLEDAI-2K of pleuritis came out in the univariate and multivariate analyses as being associated with vascular events.

Why does pleuritis show up as a signal in two different analyses of a multicentre study? While it may be a surrogate marker of just bad disease, it is certainly curious. I think these results also confirm a common observation that when lupus afflicts men, it can often be bad – very bad.

Regardless, appropriate treatment of ANY active lupus disease and aggressive management of traditional cardiovascular disease risk factors makes sense.

More reports from ACR 2015