DETECTION AND MODIFICATION OF RISK-FACTORS FOR CORONARY-ARTERY DISEASE IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS - A QUALITY IMPROVEMENT STUDY

Objective To assess the detection and control of risk factors for athe rosclerosis in patients with SLE who subsequently develop acute corona ry events. Methods Patients followed at the University of Toronto Lupu s Clinic who developed a myocardial infarction (MI) or acute coronary insufficiency (ACI) and who had 2 years of follow-up prior to their ev ent were identified and their case notes reviewed. The management of p otentially reversible risk factors in this cohort was assessed. Result s Twenty-four patients (18 female, 6 male) were studied. The mean age at the coronary event was 50 years and the mean duration of SLE was 13 .5 years. Nineteen patients had MI and 5 had ACI. Risk factors identif ied were hypertension (16), obesity/Cushing's (19), smoking (16), hype rcholesterolaemia (11), steroid use (22), hyperglycaemia (4) and cardi ac involvement with SLE (4). In the two years prior to the event, hype rtension and cardiac involvement were appropriately managed in almost all cases. Sixty percent had attempts made to reduce or stop their ste roid therapy. Two of four cases with hyperglycaemia and 5 of 11 patien ts with hypercholesterolaemia had no appropriate action noted. No smok ing advice was recorded, while one obese patient had weight reduction advice recorded. Conclusion SLE patients who develop coronary events h ave potentially reversible risk factors prior to the event. Rheumatolo gists perform well when optimizing the control of SLE, minimizing the steroid dose and managing hypertension. Other risk factors are less fa vorably managed. Physicians managing lupus patients need to play a pri mary role in screening for and managing cardiac risk factors.