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Clinical Rheumatology

, Volume 38, Issue 2, pp 457–463 | Cite as

Prolonged remission is associated with a reduced risk of cardiovascular disease in patients with systemic lupus erythematosus: a GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study

  • Serena FasanoEmail author
  • Domenico Paolo Emanuele Margiotta
  • Luciana Pierro
  • Luca Navarini
  • Antonella Riccardi
  • Antonella Afeltra
  • Gabriele Valentini
Original Article

Abstract

Prolonged remission (PR), defined as a 5-year consecutive period of no disease activity based on SLEDAI-2K, has been reported to be associated with a lower damage accrual over time in patients with systemic lupus erythematosus (SLE), as the consequence of a lower activity burden. Since disease activity is considered to play a role in the incidence of cardiovascular disease (CVD), we investigated the relationship, if any, between PR and the occurrence of a subsequent first CV event in patients with SLE. Out of 488 patients consecutively admitted to two tertiary Italian centers from November 1, 2000, to December 31, 2016, the 294 patients, who had been followed at least for 5 years, had not experienced any CV event at admission, and had been visited biannually during follow-up, were considered for the present study. The incidence of a first CV in patients who had achieved PR was compared with that registered in those who had not. Moreover, it was compared among PR patients subdivided into three groups: complete remission, clinical off-corticosteroids (offCR), and clinical on-corticosteroids remission (onCR). Kaplan–Meier curves and the log-rank test were used to analyze differences in event-free survival among groups. Cox regression was used to investigate disease and therapeutic features associated with the development of a first CV event. During 9 years median follow-up time, 24 (8.1%) CV events occurred. Out of the 294 patients, 126 (42.8%) had achieved PR. Kaplan–Meier analysis revealed a greater overall CV event-free rate in these patients as compared to both those with a shorter lasting remission and those who had never remitted (log-rank test χ2 = 14.43; p = 0.0001). In addition, CV outcome did not differ among PR patients, irrespectively the type of remission achieved (p > 0.05). At multivariate analysis, hydroxychloroquine therapy and PR resulted to be protective (HR 0.19; HR 0.18), while arterial hypertension and antiphospholipid positivity increased the risk of a first CV event (HR 2.61; HR 2.47). The PR, whichever the subtype, is associated with a better CV outcome and should be considered as a treat-to-target goal in the CV risk management of the lupus patient.

Keywords

Cardiovascular disease Remission Systemic lupus erythematosus 

Notes

Compliance with ethical standards

Disclosures

None.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Serena Fasano
    • 1
    Email author
  • Domenico Paolo Emanuele Margiotta
    • 2
  • Luciana Pierro
    • 1
  • Luca Navarini
    • 2
  • Antonella Riccardi
    • 1
  • Antonella Afeltra
    • 2
  • Gabriele Valentini
    • 1
  1. 1.Division of Rheumatology, Department of Precision MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
  2. 2.Clinical Medicine and Rheumatology DepartmentCampus Bio-Medico University of RomeRomeItaly

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