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To the Editor:

I read with interest the article by Costenbader et al in the December issue of Arthritis Care & Research (Costenbader KH, Wright E, Liang MH, Karlson EW. Cardiac risk factor awareness and management in patients with systemic lupus erythematosus. Arthritis Rheum 2004;51:983–8). This study documents what health professionals have always believed were shortcomings in addressing the cardiac issues of patients with systemic lupus erythematosus (SLE). The Framingham Offspring Study addresses the significantly higher risk of myocardial infarction in women with SLE. Also, we know that in patients with SLE, the cardiac risk is much greater than can be attributed to the presence of traditional cardiac risk factors (CRFs).

I would like to share the results of a study of patients with SLE (predominantly of African American ethnicity) followed at the University of Chicago from July 1, 1999 to July 1, 2002. We used a questionnaire concerning the presence of traditional CRFs and history of any thromboembolic events. This study was part of a larger study on contraceptive use among women 18–45 years of age with SLE. A total of 102 patients responded. The mean ± SD age of our cohort was 34.51 ± 6.97 years. Twenty-nine percent of the patients were white and 60% were African American. The self-reported prevalence rate of hypercholesterolemia was 21%. Hypertension was present in 32%, and 5% had diabetes. Less than 1% of patients had a history of myocardial infarction. Smokers comprised 23% of the cohort. Six percent of the patients had a significant family history of myocardial infarction. Nineteen percent had experienced deep vein thrombosis, and 7.7% had a history of pulmonary embolism.

Our patients were younger, of different ethnicity, and were all women. Because these were self-reported rates, they may be lower than the actual figures. The prevalence of myocardial events was lower in our cohort when compared with a study with similar ethnic makeup by Petri et al (Petri M, Perez-Gutthann S, Spence D, Hochberg MC. Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med 1992;93:513–9). This may be due to collective inclusion of angina, myocardial infarction, and cardiac sudden death in the latter study.

I would like to emphasize the need to also study C-reactive protein and its association with cardiac events among patients with SLE, and the need for appropriate yearly screening for the modifiable traditional CRFs.

Meenakshi Jolly MD*, * University of Illinois at Chicago Oaklawn, IL.