Table 3.
Rates of Cardiovascular Events by Systemic Lupus Erythematosus-Related Risk Factors, Baltimore, Maryland, 1987–2010
| Subgroup | Observed No. of CVEs | Person-Years of Follow-up | Rate of Events per 1,000 Person- Years | Rate Ratio Adjusted for Agea | 95% CI | P Adjusted for Agea |
|---|---|---|---|---|---|---|
| Duration of SLE, years | ||||||
| <3 | 25 | 1,852 | 13.5 | 1.00 | Referent | |
| 3–6 | 18 | 1,928 | 9.3 | 0.63 | 0.34, 1.15 | 0.13 |
| 6–10 | 29 | 2,168 | 13.4 | 0.84 | 0.49, 1.44 | 0.53 |
| 10–15 | 24 | 1,731 | 13.9 | 0.81 | 0.46, 1.42 | 0.46 |
| ≥15 | 38 | 1,807 | 21.0 | 1.02 | 0.61, 1.71 | 0.94 |
| Age at diagnosis, years | ||||||
| <40 | 77 | 7,147 | 10.8 | 1.00 | Referent | |
| 40–49 | 22 | 1,480 | 14.9 | 0.77 | 0.45, 1.31 | 0.33 |
| 50–59 | 24 | 606 | 39.6 | 1.49 | 0.82, 2.70 | 0.19 |
| ≥60 | 11 | 212 | 51.8 | 1.22 | 0.51, 2.90 | 0.66 |
| Recent SELENA-SLEDAI index | ||||||
| 0 | 36 | 3,792 | 9.5 | 1.00 | Referent | |
| 1 or 2 | 30 | 2,421 | 12.4 | 1.44 | 0.89, 2.35 | 0.14 |
| 3 or 4 | 31 | 1,787 | 17.3 | 2.09 | 1.29, 3.39 | 0.0027 |
| ≥5 | 37 | 1,485 | 24.9 | 3.36 | 2.11, 5.34 | <0.0001 |
| Mean SELENA-SLEDAI index | ||||||
| 0–1 | 23 | 2,125 | 10.8 | 1.00 | Referent | |
| 1–2.5 | 35 | 2,875 | 12.2 | 1.23 | 0.73, 2.09 | 0.44 |
| 2.5–5 | 49 | 3,091 | 15.9 | 1.79 | 1.09, 2.94 | 0.023 |
| ≥5 | 27 | 1,393 | 19.4 | 2.78 | 1.57, 4.91 | 0.0004 |
| History of musculoskeletal activity | ||||||
| No | 63 | 4,902 | 12.9 | 1.00 | Referent | |
| Yes | 71 | 4,584 | 15.5 | 1.04 | 0.74, 1.46 | 0.83 |
| Recent musculoskeletal activity | ||||||
| No | 115 | 8,761 | 13.1 | 1.00 | Referent | |
| Yes | 19 | 723 | 26.2 | 1.78 | 1.09, 2.89 | 0.021 |
| History of skin activity | ||||||
| No | 51 | 3,468 | 14.7 | 1.00 | Referent | |
| Yes | 83 | 6,017 | 13.8 | 0.88 | 0.62, 1.25 | 0.48 |
| Recent skin activity | ||||||
| No | 106 | 7,893 | 13.4 | 1.00 | Referent | |
| Yes | 28 | 1,593 | 17.6 | 1.32 | 0.87, 2.01 | 0.19 |
| History of immunologic activity | ||||||
| No | 40 | 2,744 | 14.6 | 1.00 | Referent | |
| Yes | 94 | 6,741 | 13.9 | 1.13 | 0.78, 1.64 | 0.54 |
| Recent immunologic activity | ||||||
| No | 69 | 5,814 | 11.9 | 1.00 | Referent | |
| Yes | 65 | 3,671 | 17.7 | 1.85 | 1.31, 2.61 | 0.0005 |
| Renal involvement | ||||||
| None | 66 | 5,112 | 12.9 | 1.00 | Referent | |
| Protein in urine | 27 | 2,118 | 12.7 | 1.14 | 0.73, 1.79 | 0.56 |
| Nephrotic syndrome | 6 | 891 | 6.7 | 0.69 | 0.30, 1.60 | 0.39 |
| Renal insufficiency | 35 | 1,364 | 25.7 | 2.03 | 1.34, 3.05 | 0.0007 |
| Recent renal activity | ||||||
| No | 115 | 8,662 | 13.3 | 1.00 | Referent | |
| Yes | 19 | 823 | 23.1 | 2.14 | 1.31, 3.89 | 0.0023 |
| Most recent serum creatinine, mg/dL | ||||||
| <1.0 | 69 | 6,934 | 10.0 | 1.00 | Referent | |
| 1.0–1.19 | 35 | 1,458 | 24.0 | 2.16 | 1.44, 3.25 | 0.0002 |
| ≥1.20 | 30 | 1,090 | 27.5 | 2.36 | 1.53, 3.64 | <0.0001 |
| History of hemolytic anemia | ||||||
| No | 113 | 8,571 | 13.2 | 1.00 | Referent | |
| Yes | 21 | 899 | 23.4 | 2.04 | 1.28, 3.25 | 0.0028 |
| Recent hematocrit | ||||||
| Normal | 88 | 6,233 | 12.5 | 1.00 | Referent | |
| Lowb | 56 | 3,250 | 17.2 | 1.56 | 1.10, 2.20 | 0.012 |
| History of low C3 | ||||||
| No | 47 | 3,830 | 12.3 | 1.00 | Referent | |
| Yes | 87 | 5,652 | 15.4 | 1.63 | 1.13, 2.34 | 0.0082 |
| Recent low C3 | ||||||
| No | 91 | 7,294 | 12.5 | 1.00 | Referent | |
| Yes | 42 | 2,188 | 19.1 | 1.95 | 1.04, 2.84 | 0.0004 |
| History of low C4 | ||||||
| No | 59 | 4,583 | 12.9 | 1.00 | Referent | |
| Yes | 75 | 4,899 | 15.3 | 1.55 | 1.10, 2.20 | 0.013 |
| Recent low C4 | ||||||
| No | 104 | 7,735 | 13.4 | 1.00 | Referent | |
| Yes | 13 | 810 | 16.0 | 1.62 | 0.90, 2.90 | 0.11 |
| History of anti-dsDNA | ||||||
| No | 48 | 3,594 | 13.4 | 1.00 | Referent | |
| Yes | 96 | 5,886 | 14.6 | 1.33 | 0.90, 1.96 | 0.15 |
| Recent anti-dsDNA | ||||||
| No | 83 | 6,992 | 11.9 | 1.00 | Referent | |
| Yes | 50 | 2,488 | 20.1 | 2.14 | 1.50, 3.06 | <0.0001 |
| Lupus anticoagulant | ||||||
| Never positive | 72 | 6,608 | 10.9 | 1.00 | Referent | <0.0001 |
| Positive at any time | 62 | 2,741 | 22.6 | 2.11 | 1.50, 2.97 | |
| Never assessed | 0 | 137 |
Abbreviations: C3, complement component 3; C4, complement component 4; CI, confidence interval; CVE, cardiovascular event; dsDNA, double stranded DNA; SELENA, Safety of Estrogens in Lupus Erythematosus National Assessment; SLE, systemic lupus erythematosus; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index instrument score.
a Age refers to the age of the patient at each month of follow-up.
b “Low” means less than 36% for females and less than 41% for males.