{
  "abstract": "Objectives To test whether excess cardiovascular (CV) risk and mortality in systemic lupus erythematosus (SLE) are concentrated in patients with lupus nephritis (LN) and/or antiphospholipid antibody–positive (aPL+)Methods Retrospective, population-based inception cohort in a 27-county U.S. Midwest region (1976–2018) with follow-up through 31Dec2023. SLE incidence was the first date meeting 2019 EULAR/ACR criteria. Patients with SLE were matched 2:1 to non-SLE comparators by age, sex, race/ethnicity, and county. A time-dependent lupus-state exposure model assigned person-time to non-renal, aPL-negative SLE; LN (biopsy-confirmed or proteinuria is greater than or equal to 500 mg/24h); or aPL+ (lupus anticoagulant or IgG anticardiolipin/anti–Beta 2-glycoprotein I is greater than or equal to 40 GPL). Patients with both were classified as LN ( figure 1). Outcomes were myocardial infarction (MI), stroke/TIA, and CV-related death. Analyses excluded patients with prior CV events. Cox models with time-dependent covariates estimated adjusted hazard ratios (HRs).Results Among 376 SLE and 752 comparators (median age 45; 80.6% women), median follow-up was 9.6 years (IQR 6.6-14.6) ( table 1). Among SLE patients, 101 had LN and 69 were aPL+; 29 had both. Versus comparators, SLE had higher risks of MI (HR:2.01, 95%CI:1.26–3.21), stroke/TIA (HR:2.58, 95%CI:1.66–4.03), and any CV event (HR:2.45, 95%CI:1.75–3.44), while CV-related death did not differ significantly (HR:1.47, 95%CI:0.77–2.80) (table 2). In time-dependent analyses, risk concentrated among LN for MI (HR:3.57, 95%CI:1.82–6.99), stroke/TIA (HR:3.80, 95%CI:1.99–7.26), any CV event (HR:4.11, 95%CI:2.51–6.74), and CV-related death (HR:3.86, 95%CI:1.53–9.69) and aPL+ for MI (HR:3.57, 95%CI:1.82–6.99), stroke/TIA (HR:3.83, 95%CI:1.69–8.69), and any CV event (HR:3.37, 95%CI:1.72–6.62). SLE patients who remained non-renal and aPL-negative did not show statistically significant excess risk for any CV outcome (table 3).Abstract PT6:01 Figure and TablesConclusions In this population-based inception study, excess CV risk in SLE was concentrated among patients who developed LN or became aPL+, whereas those remaining non-renal and aPL-negative had no significant excess risk. Because LN and aPL+ status are routinely ascertained, this phenotype-based stratification is simple to implement and more actionable than generic CV risk calculators, which often underestimate SLE risk, supporting targeted prevention and monitoring.",
  "authors": [
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Erika Navarro-Mendoza"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Isabella Mella-Bonilla"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Mario Bautista-Vargas"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Jaime Flores-Gouyonnet"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Gabriel Figueroa-Parra"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Mariana González-Treviño"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Georges El-Hasbani"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Marlon J Sandino-Bermúdez"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Alain Sanchez-Rodriguez"
    },
    {
      "affiliations": [
        "Mayo Clinic, Department of Quantitative Health Sciences, Rochester, USA"
      ],
      "name": "Cassondra A Hulshizer"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA",
        "Mayo Clinic, Department of Quantitative Health Sciences, Rochester, USA"
      ],
      "name": "Cynthia S Crowson"
    },
    {
      "affiliations": [
        "Mayo Clinic, Division of Rheumatology, Rochester, USA"
      ],
      "name": "Ali Duarte-García"
    }
  ],
  "title": "PT6:01 Cardiovascular risk in SLE is concentrated among lupus nephritis and aPL-positive subgroups: a population-based inception cohort study",
  "uid": "a294a639-aa6a-597f-b59f-1c0b0146267c"
}