Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus

Objective. The frequency of coronary heart disease (CHD) and stroke are inc reased in systemic lupus erythematosus (SLE), but the extent of the increas e is uncertain. We sought to determine to what extent the increase could no t be explained by common risk factors. Methods. The participants at two SLE registries were assessed retrospective ly for the baseline level of the Framingham study risk factors and for the presence of vascular outcomes: nonfatal myocardial infarction (MI), death d ue to CHD, overall CHD (nonfatal MI, death due to CHD, angina pectoris, and congestive heart failure due to CHD), and stroke. For each patient, the pr obability of the given outcome was estimated based on the individual's risk profile and the Framingham multiple logistic regression model, corrected f or observed followup. Ninety-five percent confidence intervals (95% CIs) we re estimated by bootstrap techniques. Results. Of 296 SLE patients, 33 with a vascular event prior to baseline we re excluded. Of the 263 remaining patients, 34 had CHD events (17 nonfatal MIs, 12 CHD deaths) and 16 had strokes over a mean followup period of 8.6 y ears. After controlling for common risk factors at baseline, the increase i n relative risk for these outcomes was 10.1 for nonfatal MI (95% C1 5.8-15. 6), 17.0 for death due to CHD (95% CI 8.1-29.7), 7.5 for overall CHD (95% C I 5.1-10.4), and 7.9 for stroke (95% CI 4.0-13.6). Conclusion. There is a substantial and statistically significant increase i n CHD and stroke in SLE that cannot be fully explained by traditional Frami ngham risk factors alone.