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Systemic Lupus Erythematosus
Cardiovascular disease and cognitive dysfunction in systemic lupus erythematosus†
Article first published online: 27 AUG 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 9, pages 1328–1333, September 2012
How to Cite
Murray, S. G., Yazdany, J., Kaiser, R., Criswell, L. A., Trupin, L., Yelin, E. H., Katz, P. P. and Julian, L. J. (2012), Cardiovascular disease and cognitive dysfunction in systemic lupus erythematosus. Arthritis Care Res, 64: 1328–1333. doi: 10.1002/acr.21691
- Issue published online: 27 AUG 2012
- Article first published online: 27 AUG 2012
- Accepted manuscript online: 1 MAY 2012 11:42AM EST
- Manuscript Accepted: 28 MAR 2012
- Manuscript Received: 19 OCT 2011
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: P60-AR053308, K08-MH0727240, R01-AR22804, K24-AR02175
- Arthritis Foundation Post-Doctoral Fellowship Award
- Kirkland Scholar Award
- Rosalind Russell Medical Research Center for Arthritis
- National Center for Research Resources
- US Public Health Service. Grant Number: 5-M01-R-00079
- General Clinical Research Center
- Moffitt Hospital
- University of California, San Francisco
Cognitive dysfunction and cardiovascular disease are common and debilitating manifestations of systemic lupus erythematosus (SLE). In this study, we evaluated the relationship between cardiovascular events, traditional cardiovascular risk factors, and SLE-specific risk factors as predictors of cognitive dysfunction in a large cohort of participants with SLE.
Subjects included 694 participants from the Lupus Outcomes Study (LOS), a longitudinal study of SLE outcomes based on an annual telephone survey querying demographic and clinical variables. The Hopkins Verbal Learning Test-Revised and the Controlled Oral Word Association Test were administered to assess cognitive function. Multiple logistic regression was used to identify cardiovascular events (myocardial infarction, stroke), traditional cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking), and SLE-specific risk factors (antiphospholipid antibodies [aPL], disease activity, disease duration) associated with cognitive impairment in year 7 of the LOS.
The prevalence of cognitive impairment as measured by verbal memory and verbal fluency metrics was 15%. In adjusted multiple logistic regression analyses, aPL (odds ratio [OR] 2.10, 95% confidence interval [95% CI] 1.3–3.41), hypertension (OR 2.06, 95% CI 1.19–3.56), and a history of stroke (OR 2.27, 95% CI 1.16–4.43) were significantly associated with cognitive dysfunction. In additional analyses evaluating the association between these predictors and severity of cognitive impairment, stroke was significantly more prevalent in participants with severe impairment when compared to those with mild or moderate impairment (P = 0.036).
These results suggest that the presence of aPL, hypertension, and stroke are key variables associated with cognitive impairment, which may aid in identification of patients at greatest risk.