Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups
Abstract
OBJECTIVE: To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds. METHODS: SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins. RESULTS: We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean +/- SD age at SLE diagnosis was 35.7 +/- 14 years. After a followup of 3,094 patient-years, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P = 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events. CONCLUSION: There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.
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The higher incidence of thromboembolic events observed in this study may be attributable to the selection of a high-risk antiphospholipid-positive population.
“the higher incidence of TEs recorded in this study may be related to the selection of high-risk aPL-positive population”
From Incidence of a first thromboembolic event in asymptomatic carriers of high-risk antiphospholipid antibody profile: a multicenter prospective study (2011) · cites this paper as [16]
The annual rate in a cohort of SLE patients, half of whom had antiphospholipid antibodies, was 2.9 per 100 patient-years.
“Annual rate in a cohort of SLE patients half of whom had aPL was 2.9 per 100 patientyears.16”
From Incidence of a first thromboembolic event in asymptomatic carriers of high-risk antiphospholipid antibody profile: a multicenter prospective study (2011) · cites this paper as [16]
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- Authors
- Mok, C. C., Tang, S. S. K., To, C. H., & Petri, M.
- Affiliations
- Tuen Mun Hospital (CN)
- Johns Hopkins University (US)
- Venue
- Arthritis & Rheumatism
- Publisher
- Wiley
- Published
- 2005-09
- Volume
- 52
- Issue
- 9
- Pages
- 2774-2782
- ISSN
- 0004-3591 (ISSN-L)
- 1529-0131
- OpenAlex
- W2009780111
- Cited by
- 237
- References
- 48
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 10 · 2023: 12 · 2022: 12 · 2021: 11 · 2020: 16 · 2019: 12 · 2018: 11 · 2017: 11 · 2016: 17 · 2015: 10 · 2014: 20 · 2013: 13 · 2012: 15
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis & Rheumatism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR43727, R01AR043727)
- National Center for Research Resources (M01 RR-00052, M01RR000052)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- systemic lupus erythematosus, thromboembolism, arterial thrombosis, venous thrombosis, ethnic differences, Chinese patients, African Americans, Caucasians, risk factors, antiphospholipid antibodies, HDL cholesterol, smoking, obesity, oral ulcers, serositis, antimalarial drugs, exogenous estrogen
- MeSH terms
- Adult, Black or African American, Ethnicity, Female, Hong Kong, Humans, Lupus Erythematosus, Systemic, Male, Maryland, Prospective Studies, Risk Factors, Thromboembolism, Incidence, Proportional Hazards Models, White People, Asian People
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