Primary cardiac disease in systemic lupus erythematosus patients: protective and risk factors--data from a multi-ethnic Latin American cohort

• Published in: Rheumatology (Oxford, England) Vol. 53; no. 8; pp. 1431 - 1438
• Main Authors: García, Mercedes A, Alarcón, Graciela S, Boggio, Gabriela, Hachuel, Leticia, Marcos, Ana Inés, Marcos, Juan Carlos, Gentiletti, Silvana, Caeiro, Francisco, Sato, Emilia I, Borba, Eduardo F, Brenol, João C Tavares, Massardo, Loreto, Molina-Restrepo, José Fernando, Vásquez, Gloria, Guibert-Toledano, Marlene, Barile-Fabris, Leonor, Amigo, Mary-Carmen, Huerta-Yáñez, Guillermo F, Cucho-Venegas, Jorge M, Chacón-Diaz, Rosa, Pons-Estel, Bernardo A
• Format: Journal Article
• Language: English
• Published: England 01-08-2014
• Subjects: Age of Onset; Aged; Cause of Death; Comorbidity; Female; Heart Diseases - epidemiology; Heart Diseases - mortality; Humans; Incidence; Latin America - epidemiology; Lupus Erythematosus, Systemic - epidemiology; Lupus Erythematosus, Systemic - mortality; Male; Middle Aged; Risk Factors; Severity of Illness Index; Latin America; antimalarials; mortality; cardiac disease; systemic lupus erythematosus; survival
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keu011

The aim of this study was to assess the cumulative incidence, risk and protective factors and impact on mortality of primary cardiac disease in SLE patients (disease duration ≤2 years) from a multi-ethnic, international, longitudinal inception cohort (34 centres, 9 Latin American countries).
Risk and protective factors of primary cardiac disease (pericarditis, myocarditis, endocarditis, arrhythmias and/or valvular abnormalities) were evaluated.
Of 1437 patients, 202 (14.1%) developed one or more manifestations: 164 pericarditis, 35 valvulopathy, 23 arrhythmias, 7 myocarditis and 1 endocarditis at follow-up; 77 of these patients also had an episode of primary cardiac disease at or before recruitment. In the multivariable parsimonious model, African/Latin American ethnicity [odds ratio (OR) 1.80, 95% CI 1.13, 2.86], primary cardiac disease at or before recruitment (OR 6.56, 95% CI 4.56, 9.43) and first SLICC/ACR Damage Index for SLE assessment (OR 1.31, 95% CI 1.14, 1.50) were risk factors for the subsequent occurrence of primary cardiac disease. CNS involvement (OR 0.44, 95% CI 0.25, 0.75) and antimalarial treatment (OR 0.62, 95% CI 0.44, 0.89) at or before recruitment were negatively associated with the occurrence of primary cardiac disease risk. Primary cardiac disease was not independently associated with mortality.
Primary cardiac disease occurred in 14.1% of SLE patients of the Grupo Latino Americano de Estudio de Lupus cohort and pericarditis was its most frequent manifestation. African origin and lupus damage were found to be risk factors, while CNS involvement at or before recruitment and antimalarial treatment were protective. Primary cardiac disease had no impact on mortality.