1. Assessment of coronary risk based on cumulative exposure to lipids in systemic lupus erythematosus.
- Author
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Nikpour M, Gladman DD, Ibanez D, Harvey PJ, and Urowitz MB
- Subjects
- Adult, Angina Pectoris epidemiology, Angina Pectoris metabolism, Cholesterol, HDL blood, Cholesterol, LDL blood, Death, Sudden, Cardiac epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction epidemiology, Myocardial Infarction metabolism, Proportional Hazards Models, Risk Assessment methods, Risk Factors, Sensitivity and Specificity, Triglycerides blood, Coronary Artery Disease epidemiology, Coronary Artery Disease metabolism, Lipids blood, Lupus Erythematosus, Systemic epidemiology, Lupus Erythematosus, Systemic metabolism
- Abstract
Objective: To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE)., Methods: Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient. Time-dependent proportional hazards regression models were used to quantify the risk of coronary event [myocardial infarction (MI) or angina], after adjustment for age., Results: Among 384 patients, over a mean (SD) followup of 3.81 (2.58) years, there were 21 "first" coronary events (6 MI, 15 angina). Mean and TAM LDL-C (HR 1.83, 95% CI 1.19-2.81, p = 0.006), TC:HDL ratio (HR 1.43, 95% CI 1.02-2.00, p = 0.04), and TG (HR 2.11, 95% CI 1.32-3.39, p = 0.0019) were predictive of coronary event at subsequent visits. In contingency table analysis, TAM LDL-C cutpoint of 2.0 mmol/l had a sensitivity and negative predictive value for coronary event of 85.7% (95% CI 63.7-97.0) and 93.9% (95% CI 83.1-98.7), respectively. However, at this cutpoint the specificity was only 12.7% (95% CI 9.4-16.5)., Conclusion: This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.
- Published
- 2013
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