Original article
The pulse-mass index as a predictor of cardiovascular events in women with systemic lupus erythematosusEl índice pulso-masa como factor pronóstico de eventos cardiovasculares en mujeres con lupus eritematoso sistémico☆

https://doi.org/10.1016/j.medcle.2016.09.034Get rights and content

Abstract

Background

Patients with systemic lupus erythematosus (SLE) have 3 times the risk of death compared to the rest of the population, with cardiovascular events (CVD) being one of the main causes. Indices such as waist-height (W-Ht I), waist-hip (W-Hp I) and pulse-mass (PMI) predict CVD, though the behaviour is unknown in patients with SLE. The aim of this study was to determine the prognostic value of PMI in the development of CVD in premenopausal women with SLE.

Methodology

Cohort study. Included were premenopausal women with SLE without prior CVD; excluded were those patients with antiphospholipid syndrome (APS), pregnancy, thyroid disease, recent liposuction, and chronic kidney disease. Exposure variables were: PMI, W-Ht I, W-Hp I and metabolic syndrome at onset of the cohort. Considered confounding variables were time of evolution, disease activity, cumulative damage and treatment. Through semi-annual appointments, accident and emergency admittance and hospitalization records the CVD were screened. Analysis was performed with Cox for proportional hazards and survival with Kaplan Meier.

Results

We included 238 women with a median age of 31 (18–52) years, with a follow-up of 8 years. We identified 22 (9.6%) cases of CVD. In the Cox proportional hazards analysis, the prognostic variables were: PMI with HR = 8.1 (95% CI: 1.1–65), metabolic syndrome with 2.4 (95% CI: 1–5.8), cumulative damage with HR = 1.5 (95% CI: 1.1–2.2) and body fat percentage HR = 2.8 (95% CI: 1.1–6.9).

Conclusions

The PMI is a better predictor factor of CVD in women with SLE.

Resumen

Antecedentes

Los enfermos de lupus eritematoso generalizado (LEG), comparados con el resto de la población, tienen 3 veces más riesgo de muerte; los eventos cardiovasculares (ECV) son una de las principales causas. Existen índices como cintura-talla (ICT), cintura-cadera (ICC) y el pulso-masa (IPM) que pronostican ECV; su comportamiento se desconoce en el LEG. El objetivo de este estudio fue determinar el valour pronóstico del IPM en el desarrollo de ECV en mujeres premenopáusicas con LEG.

Metodología

Estudio de cohorte. Se incluyó a mujeres premenopáusicas con LEG, sin ECV previo; se excluyó a las pacientes que presentaran síndrome antifosfolípido (SAF), que estuvieran embarazadas, con enfermedad tiroidea, liposucción reciente y enfermedad renal crónica.

Las variables de exposición fueron: IPM, ICT, ICC y síndrome metabólico al momento del ingreso a la cohorte. Se consideraron como variables confusoras el tiempo de evolución, actividad de la enfermedad, daño acumulado y tratamiento. Por medio de citas semestrales, registro de urgencias y hospitalización, se midieron los ECV.

Se utilizó análisis de riesgos proporcionales de Cox y sobrevida por Kaplan–Meier.

Resultados

Se incluyó a 238 mujeres con mediana de edad de 31 años (18-52), con seguimiento de 8 años. Se presentaron 22 casos (9,6%) de ECV. En el análisis de regresión de Cox las variables pronósticas fueron: IPM con HR = 8,1 (IC95%: 1,1-65), síndrome metabólico con 2,4 (IC95%: 1-5,8), daño acumulado con HR = 1,5 (IC95%: 1,1-2,2) y porcentaje de grasa corporal con HR = 2,8 (IC95%: 1,1-6,9).

Conclusiones

El IPM es un buen factor pronóstico de ECV en mujeres con LEG.

Introduction

Mortality in patients with systemic lupus erythematosus (SLE) is 3 times greater than in the rest of the population.1 One of the main causes is cardiovascular events (CVE)2; and its frequency varies according to cohorts, between 8 and 15%.3, 4

Traditional cardiovascular risk factors have a higher prevalence,5 although its prognostic effect is lower when compared to other variables such as male sex, disease activity, cumulative damage, neurological damage or the presence of autoantibodies.6, 7

The best predictor is one that is quickly accessible, has a lower cost and it is easy to measure; and in the case of CVE, it is known that a body mass index (BMI) greater than 25 kg/m2 and metabolic syndrome (MS) represent an even higher risk than traditional factors in women with SLE.8 There are other ratios such as waist-to-height ratio (WHtR) or waist-to-hip ratio (WHR) evaluating the effect of abdominal obesity in the development of atheromatous disease in people without rheumatic diseases.9

In the Framingham cohort, pulse-mass index (PMI) was described as a possible factor in predicting CVE, based on the relationship between body mass index (BMI) and pulse, which indirectly reflects the sympathetic effect.10 There are no studies linking anthropometric ratios with PMI in SLE population.

The aim of this study was to determine the prognostic value of PMI in the development of CVE in premenopausal women with SLE.

Section snippets

Methodology

After approval by the Local Clinical Research Ethics Committee, a closed cohort study11 was conducted, from 2001 to 2008, in women with SLE at the Salvador Zubiran National Institute of Medical Sciences and Nutrition in Mexico City. It included women aged ≥18 years, premenopausal, with the SLE classification criteria (≥4 criteria of the American College of Rheumatology),12 no history of CVE and who signed the informed consent; women who were pregnant, with uncontrolled thyroid disease, with

Results

238 patients with a total follow-up time of 1352 patient-years and median follow-up of 6.3 years (interquartile range: 3 to 7.8) were included in the study.

The median age was 31 years (18–52), time to disease progression was 8.2 years (0.2 to 32.5). The summary of the distribution of clinical, anthropometric and biochemical variables is shown in Table 1 according to the presence or absence of CVE.

Of the total, 22 women (9.6%) developed CVE with a median presentation time of 5.88 years. The

Discussion

The role of PMI as a predictor of CVE compared with other variables already known (cumulative damage, MS, disease activity) was demonstrated in this study. The population of this cohort represents the real epidemiological situation of women with SLE, that is, women between the third and fourth decades of life in immunosuppressive therapy based on corticosteroids.17 The homogeneity of the population was confirmed because of these characteristics. It was decided not to search for new cut-off

Conflict of interests

The authors declare no conflict of interest.

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    Please cite this article as: García-Villegas EA, Márquez-González H, Flores-Suárez LF, Villa-Romero AR. El índice pulso-masa como factor pronóstico de eventos cardiovasculares en mujeres con lupus eritematoso sistémico. Med Clin (Barc). 2017;148:57–62.

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