Introduction
Materials and methods
Patients
Methods
Measurement of TC, SBP, and DBP
Calculation of "summary measures" of TC, SBP, and DBP
Covariates
Outcome variables
Univariate comparisons
Time-constant regression models
Time-dependent regression models
Results
BP Dataset | TC Dataset | |
---|---|---|
n(%) or mean ± SD | n(%) or mean ± SD | |
Number of patients | 991 | 956 |
Female | 879 (88.7%) | 849 (88.8%) |
Race | ||
Caucasian | 70% | 70% |
Black | 11% | 11% |
Asian | 11% | 11% |
Other | 8% | 8% |
CAD events | ||
MI Angina | 25 75 | 20 71 |
Sudden cardiac death | 2 | 2 |
Total | 94 | 86 |
Agea | ||
At diagnosis | 31.0 ± 13.8 | 30.9 ± 13.8 |
At study entry | 37.1 ± 14.0 | 37.5 ± 14.1 |
Disease durationa | ||
At first clinic visit | 4.0 ± 5.8 | 4.0 ± 5.9 |
At study entry | 6.1 ± 7.9 | 6.6 ± 8.1 |
SLEDAI-2Kb | ||
At first clinic visit | 9.7 ± 7.7 | 9.6 ± 7.7 |
At study entry | 9.2 ± 7.5 | 8.3 ± 7.2 |
SLICC/ACR-DIc | ||
At first clinic visit | 0.3 ± 0.7 | 0.3 ± 0.7 |
At study entry | 0.5 ± 1.2 | 0.6 ± 1.2 |
Steroids at study entry | 623 (63%) | 625 (65.6%) |
Antimalarials at study entryd | 380 (38.5%) | 385 (40.4%) |
Immunosuppressivese | ||
At study entry | 235 (23.8%) | 233 (24.5%) |
Hypertension at study entryf | 221 (22.3%) | 212 (22.6%) |
Hypercholesterolemia at study entryg | 344 (41.8%) | 408 (42.7%) |
Diabetes at study entryh | 28 (2.9%) | 31 (3.3%) |
Smoker at study entryi | 190 (19.5%) | 183 (19.5%) |
Antihypertensive use | ||
at study entryj | 174/691 (25.2%) | 174/699 (24.9%) |
Lipid-lowering meds | ||
at study entryk | 23/440 (5.2%) | 22/440 (5.0%) |
Summary measures for BP
Summary measures for TC
Univariate comparisons
BP models | TC models | |||||
---|---|---|---|---|---|---|
CAD (n = 94) | No CAD (n = 897) | CAD (n = 86) | No CAD (n = 870) | |||
n(%) or mean ± SD | n(%) or mean ± SD |
P
| n(%) or mean ± SD | n(%) or mean ± SD |
P
| |
Female | 72 (83.7%) | 777 (89.3%) | 0.12 | 78 (83.0%) | 801 (89.3%) | 0.07 |
Menopausea at study start | 32 (44.4%) | 184 (23.7%) | 0.0001 | 33 (42.3%) | 189 (23.6%) | 0.0003 |
Race | ||||||
Caucasian | 75 (87.2%) | 574 (68.6%) | 0.004 | 81 (86.2%) | 593 (68.7%) | 0.005 |
Black | 3 (3.5%) | 96 (11.5%) | 4 (4.3%) | 97 (11.2%) | ||
Asian | 4 (4.7%) | 94 (11.2.%) | 4 (4.3%) | 97 (11.2%) | ||
Other | 4 (4.7%) | 73 (8.7%) | 5 (5.3%) | 76 (8.8%) | ||
Disease durationb | ||||||
At first visit | 4.08 ± 5.71 | 4.01 ± 5.87 | 0.92 | 4.24 ± 5.72 | 3.94 ± 5.80 | 0.63 |
At study start | 6.99 ± 7.84 | 6.54 ± 8.17 | 0.62 | 5.95 ± 7.23 | 6.13 ± 8.00 | 0.83 |
SLEDAI-2Kc | ||||||
At first visit | 12.34 ± 8.67 | 9.49 ± 7.63 | 0.001 | 12.16 ± 8.63 | 9.60 ± 7.65 | 0.002 |
At study start | 9.59 ± 7.99 | 8.28 ± 7.26 | 0.11 | 11.36 ± 8.86 | 9.02 ± 7.50 | 0.02 |
Disease manifestationsd ever from diagnosis to first visit | ||||||
Musculoskeletal | 42 (44.7%) | 365 (40.7%) | 0.45 | 44 (51.2%) | 363 (41.7%) | 0.09 |
Cutaneous | 69 (73.4%) | 504 (56.2%) | 0.001 | 65 (75.6%) | 507 (58.3%) | 0.002 |
Renal | 46 (48.9%) | 364 (40.6%) | 0.12 | 47 (54.7%) | 370 (42.5%) | 0.03 |
Nervous system | 32 (34.0%) | 180 (20.1%) | 0.002 | 32 (37.2%) | 189 (21.7%) | 0.001 |
Hematologic | 13 (13.8%) | 110 (12.3%) | 0.66 | 14 (16.3%) | 117 (13.5%) | 0.47 |
Vasculitis | 19 (20.2%) | 126 (14.1%) | 0.11 | 19 (22.1%) | 133 (15.3%) | 0.10 |
Immunologic | 58 (61.7%) | 640 (71.4%) | 0.05 | 62 (72.1%) | 637 (73.2%) | 0.82 |
Serosal | 13 (13.8%) | 77 (8.6%) | 0.09 | 11 (12.8%) | 74 (8.5%) | 0.18 |
Fever | 16 (17.0%) | 141 (15.7%) | 0.74 | 18 (20.9%) | 138 (15.9%) | 0.23 |
Disease manifestationse ever during follow-up | ||||||
Musculoskeletal | 70 (74.5%) | 508 (56.6%) | 0.0008 | 67 (77.9%) | 476 (54.7%) | < 0.0001 |
Cutaneous | 82 (87.2%) | 643 (71.7%) | 0.001 | 73 (84.9%) | 615 (70.7%) | 0.005 |
Renal | 72 (76.6%) | 581 (64.8%) | 0.02 | 62 (72.1%) | 547 (62.9%) | 0.09 |
Nervous system | 58 (61.7%) | 304 (33.9%) | < 0.0001 | 53 (61.6%) | 284 (32.6%) | < 0.0001 |
Hematologic | 25 (26.6%) | 229 (25.5%) | 0.82 | 22 (25.6%) | 214 (24.6%) | 0.84 |
Vasculitis | 42 (44.7%) | 207 (23.1%) | < 0.0001 | 36 (41.9%) | 189 (21.7%) | < 0.0001 |
Immunologic | 82 (87.2%) | 769 (85.7%) | 0.69 | 76 (88.4%) | 741 (85.2%) | 0.42 |
Serosal | 22 (23.4%) | 112 (12.5%) | 0.003 | 19 (22.1%) | 94 (10.8%) | 0.002 |
Fever | 42 (44.7%) | 231 (25.8%) | < 0.0001 | 40 (46.5%) | 200 (23.0%) | < 0.0001 |
Chronic renal insufficiency everf | 5 (5.3%) | 64 (7.1%) | 0.51 | 4 (4.7%) | 60 (6.9%) | 0.43 |
Anti-phospholipid antibodiesg | ||||||
Ever from first clinic visit to last visit | 69 (75.8%) | 546 (61.1%) | 0.006 | 66 (76.7%) | 527 (60.8%) | 0.004 |
Ever in the study period | 66 (72.5%) | 491 (55.0%) | 0.001 | 61 (70.9%) | 459 (53.0%) | 0.001 |
Corticosteroids | ||||||
At study start | 66 (76.7%) | 559 (68.5%) | 0.02 | 66 (70.2%) | 557 (62.2%) | 0.13 |
Ever during follow-up | 81 (94.2%) | 676 (77.7%) | 0.0003 | 88 (93.6%) | 706 (78.7%) | 0.0006 |
Cumulative steroid dose (g) | ||||||
From first clinic visit to last visit | 42.3 ± 34.4 | 31.7 ± 34.7 | 0.006 | 43.5 ± 34.6 | 31.9 ± 35.1 | 0.005 |
In the study period | 30.3 ± 25.8 | 20.5 ± 23.1 | 0.0002 | 28.8 ± 25.1 | 19.7 ± 21.9 | 0.0005 |
Antimalarialsg | ||||||
At study start | 29 (33.7%) | 356 (41.1%) | 0.18 | 31 (33.0%) | 349 (39.0%) | 0.25 |
Ever during follow-up | 51 (59.3%) | 622 (71.5%) | 0.02 | 58 (61.7%) | 639 (71.2%) | 0.05 |
Immunosuppressivesh | ||||||
At study start | 16 (18.6%) | 217 (25.1%) | 0.18 | 14 (15.1%) | 221 (24.8%) | 0.04 |
Ever during follow-up | 46 (53.5%) | 454 (52.2%) | 0.82 | 51 (54.3%) | 471 (52.5%) | 0.75 |
Hypertensioni | ||||||
At study start | 26 (31.0%) | 123 (14.4%) | < 0.0001 | 26 (27.7%) | 131 (14.6%) | 0.001 |
Ever during follow-up | 71 (82.6%) | 380 (43.7%) | < 0.0001 | 77 (81.9%) | 403 (44.9%) | < 0.0001 |
Hypercholesterolemiaj | ||||||
At study start | 26 (31.0%) | 350 (40.2%) | < 0.0001 | 39 (65.0%) | 305 (39.9%) | 0.0001 |
Ever during follow-up | 79 (91.9%) | 597 (68.6%) | < 0.0001 | 81 (91.0%) | 614 (69.1%) | < 0.0001 |
Diabetes mellitusk | ||||||
At study start | 5 (6.0%) | 29 (3.4%) | 0.22 | 4 (4.4%) | 27 (3.1%) | 0.52 |
Ever during follow-up | 13 (15.1%) | 58 (6.7%) | 0.005 | 13 (13.8%) | 61 (6.8%) | 0.01 |
Smokerl | ||||||
At study start | 20 (23.8%) | 162 (19.0%) | 0.28 | 23 (25.0%) | 166 (18.8%) | 0.15 |
Ever during follow-up | 27 (31.4%) | 220 (25.4%) | 0.22 | 30 (31.9%) | 229 (25.6%) | 0.18 |
Antihypertensivesm | ||||||
Ever up to study start | 14/37 (37.8%) | 166/642 (25.9%) | 0.11 | 16/39 (41.0%) | 169/654 (25.8%) | 0.04 |
Ever during follow-up | 69/76 (90.8%) | 355/487 (72.9%) | 0.0008 | 71/83 (85.5%) | 361/506 (71.3%) | 0.007 |
Lipid-lowering medicationsn | ||||||
Ever up to study start | 1/10 (10.0%) | 26/427 (6.1%) | 0.48 | 1/11 (9.1%) | 27/430 (6.3%) | 0.52 |
Ever during follow-up | 47/76 (61.8%) | 144/543 (26.5%) | < 0.0001 | 48/70 (68.6%) | 145/528 (27.5%) | < 0.0001 |
TC level at study starto | 5.85 ± 1.62 | 5.19 ± 1.56 | 0.0002 | |||
Mean of first two TC levelso | 5.91 ± 1.53 | 5.19 ± 1.49 | < 0.0001 | |||
Mean of all TC levelso | 5.72 ± 1.23 | 4.95 ± 1.11 | < 0.0001 | |||
AM of all TC levelso | 5.72 ± 1.23 | 4.94 ± 1.11 | < 0.0001 | |||
AUC of all TC levelsp | 15, 806 ± 13, 063 | 11, 117 ± 11, 976 | 0.0006 | |||
SBP at study starto | 131.65 ± 21.29 | 123.11 ± 19.08 | < 0.0001 | |||
Mean of first two SBPso | 132.45 ± 19.00 | 123.03 ± 17.35 | < 0.0001 | |||
Mean of all SBPso | 134.90 ± 15.32 | 121.96 ± 14.81 | < 0.0001 | |||
AM of all SBPso | 134.68 ± 15.351 | 121.88 ± 14.99 | < 0.0001 | |||
AUC of all SBPs∞p | 400, 217 ± 318, 056 | 285, 335 ± 304, 573 | 0.0006 | |||
DBP at study starto | 77.3 ± 12.3 | 80.8 ± 11.8 | 0.009 | |||
Mean of first two DBPso | 77.2 ± 10.5 | 82.0 ± 10.5 | < 0.0001 | |||
Mean of all DBPso | 76.2 ± 8.5 | 82.7 ± 6.7 | < 0.0001 | |||
AM of all DBPso | 76.2 ± 8.6 | 82.6 ± 6.8 | < 0.0001 | |||
AUC of all DBPsp | 179, 476 ± 192, 071 | 245, 236 ± 194, 324 | 0.002 |
Proportional hazards multiple regression models
TC models
Time-constant models | Time-dependent models | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
First available ("remote") TC | Average of first two TCs | Most recent TC | Mean TC | Time-adjusted mean TC | AUC TC | |||||||
HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
p
| |
Cholesterol (TC) | 1.07 (0.93, 1.22) | 0.36 | 1.08 (0.94, 1.24) | 0.30 | 1.22 (1.05, 1.42) | 0.01 | 1.22 (1.01, 1.47) | 0.04 | 1.22 (1.02, 1.47) | 0.03 | 1.00 (1.00, 1.00) | 0.29 |
Male sex | 2.02 (1.12, 3.62) | 0.02 | 2.00 (1.11, 3.59) | 0.02 | 1.84 (1.02, 3.32) | 0.04 | 1.75 (0.97, 3.18) | 0.06 | 1.74 (0.96, 3.15) | 0.07 | 1.78 (0.98, 3.23) | 0.06 |
Ageψ | 1.06 (1.04, 1.08) | < 0.0001 | 1.06 (1.04, 1.08) | < 0.0001 | 1.06 (1.05, 1.08) | < 0.0001 | 1.06 (1.05, 1.08) | < 0.0001 | 1.06 (1.04, 1.08) | < 0.0001 | 1.06 (1.04, 1.08) | < 0.0001 |
SLEDAI-2K¶ | 1.03 (1.001, 1.06) | 0.04 | 1.03 (1.00, 1.06) | 0.06 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 |
Hypertension¢ | 1.12 (0.61, 2.04) | 0.72 | 1.10 (0.60, 2.02) | 0.76 | 1.50 (0.93, 2.42) | 0.095 | 1.57 (0.97, 2.52) | 0.06 | 1.57 (0.98, 2.52) | 0.06 | 1.67 (1.05, 2.67) | 0.03 |
Corticosteroidsβ | 4.17 (1.62, 10.73) | 0.003 | 4.16 (1.62, 10.72) | 0.003 | 1.85 (1.05, 3.23) | 0.03 | 1.89 (1.08, 3.30) | 0.03 | 1.89 (1.08, 3.30) | 0.03 | 1.92 (1.10, 3.35) | 0.02 |
Antimalarials§ | 0.50 (0.31, 0.79) | 0.003 | 0.50 (0.31, 0.80) | 0.004 | 0.90 (0.57, 1.44) | 0.66 | 0.88 (0.55, 1.41) | 0.59 | 0.88 (0.55, 1.41) | 0.60 | 0.80 (0.51, 1.27) | 0.35 |
Immunosuppressives¥ | 0.79 (0.49, 1.26) | 0.32 | 0.78 (0.49, 1.25) | 0.30 | 1.32 (0.82, 2.14) | 0.25 | 1.29 (0.79, 2.08) | 0.31 | 1.29 (0.79, 2.09) | 0.31 | 1.34 (0.83, 2.17) | 0.23 |
Time-dependent covariate models | ||||||
---|---|---|---|---|---|---|
Most recent TC | Mean TC | Time-adjusted mean TC | ||||
HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| |
Cholesterol (TC) | 1.86 (1.30, 2.68) | 0.001 | 2.07 (1.28, 3.36) | 0.003 | 2.07 (1.28, 3.34) | 0.003 |
Male sex | 1.90 (1.06, 3.41) | 0.03 | 1.83 (1.01, 3.29) | 0.046 | 1.82 (1.01, 3.29) | 0.047 |
Ageψ | 1.12 (1.07, 1.17) | < 0.0001 | 1.13 (1.06, 1.20) | < 0.0001 | 1.13 (1.06, 1.20) | < 0.0001 |
SLEDAI-2K¶ | 1.09 (1.05, 1.13) | < 0.0001 | 1.10 (1.06, 1.14) | < 0.0001 | 1.10 (1.06, 1.14) | < 0.0001 |
Corticosteroidsβ | 2.04 (1.20, 3.45) | 0.01 | 2.01 (1.19, 3.41) | 0.01 | 2.01 (1.19, 3.41) | 0.01 |
SBP models
Time-constant models | Time-dependent models | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
First available ("remote") SBP | Average of first two SBP | Most recent SBP | Mean SBP | Time-adjusted mean SBP | AUC SBP | |||||||
HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95% CI) |
P
| HR (95%)I) |
p
| |
Systolic blood pressure (SBP) | 1.00 (0.99, 1.02) | 0.45 | 1.31 (0.68, 2.53) | 0.42 | 1.01 (1.00, 1.02) | 0.052 | 1.025 (1.01, 1.04) | 0.004 | 1.024 (1.01, 1.04) | 0.004 | 1.00 (1.00, 1.00) | 0.19 |
Male sex | 2.01 (1.13, 3.59) | 0.02 | 2.04 (1.14, 3.65) | 0.02 | 1.87 (1.03, 3.39) | 0.04 | 1.75 (0.96, 3.21) | 0.07 | 1.74 (0.95, 3.18) | 0.07 | 1.83 (1.00, 3.33) | 0.049 |
Ageψ | 1.05 (1.03, 1.07) | < 0.0001 | 1.05 (1.03, 1.07) | < 0.0001 | 1.06 (1.03, 1.07) | < 0.0001 | 1.04 (1.02, 1.07) | < 0.0001 | 1.04 (1.02, 1.07) | < 0.0001 | 1.06 (1.04, 1.08) | < 0.0001 |
SLEDAI-2K¶ | 1.03 (1.01, 1.06) | 0.01 | 1.03 (1.01, 1.06) | 0.01 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 |
Elevated cholesterolζ | 1.41 (0.67, 2.98) | 0.37 | 1.39 (0.66, 2.95) | 0.39 | 1.72 (1.06, 2.78) | 0.03 | 1.68 (1.04, 2.71) | 0.03 | 1.69 (1.04, 2.73) | 0.03 | 1.82 (1.13, 2.92) | 0.01 |
Corticosteroidsβ | 2.73 (1.13, 6.61) | 0.03 | 2.74 (1.13, 6.62) | 0.03 | 1.74 (0.99, 3.08) | 0.06 | 1.72 (0.98, 3.03) | 0.06 | 1.72 (0.97, 3.03) | 0.06 | 1.77 (1.00, 3.12) | 0.049 |
Antimalarials§ | 0.59 (0.37, 0.93) | 0.02 | 0.59 (0.37, 0.95) | 0.03 | 0.95 (0.60, 1.52) | 0.84 | 0.97 (0.61, 1.56) | 0.91 | 0.97 (0.61, 1.55) | 0.89 | 0.93 (0.58, 1.48) | 0.75 |
Immunosuppressives¥ | 0.91 (0.58, 1.43) | 0.68 | 0.89 (0.56, 1.41) | 0.63 | 1.51 (0.93, 2.45) | 0.10 | 1.48 (0.91, 2.40) | 0.11 | 1.48 (0.91, 2.40) | 0.11 | 1.46 (0.90, 2.36) | 0.13 |
DBP models
Time-constant models | Time-dependent models | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
First available ('remote') DBP | Average of first two DBP | Most recent DBP | Mean DBP | Time-adjusted mean DBP | AUC DBP | |||||||
HR (95% CI) |
p
| HR (95% CI) |
p
| HR (95% CI) |
p
| HR (95% CI) |
p
| HR (95% CI) |
p
| HR (95% CI) |
p
| |
Diastolic blood pressure (DBP) | 1.00 (0.98, 1.02) | 0.87 | 1.01 (0.99, 1.03) | 0.46 | 1.02 (1.003, 1.05) | 0.02 | 1.04 (1.01, 1.07) | 0.02 | 1.04 (1.01, 1.07) | 0.02 | 1.00 (1.00, 1.00) | 0.94 |
Male sex | 2.01 (1.13, 3.60) | 0.02 | 2.00 (1.12, 3.58) | 0.02 | 1.85 (1.02, 3.36) | 0.04 | 1.72 (0.94, 3.15) | 0.08 | 1.70 (0.93, 3.11) | 0.09 | 1.88 (1.03, 3.43) | 0.039 |
Ageψ | 1.05 (1.04, 1.07) | < 0.0001 | 1.05 (1.04, 1.07) | < 0.0001 | 1.06 (1.04, 1.08) | < 0.0001 | 1.06 (1.04, 1.08) | < 0.0001 | 1.06 (1.04, 1.07) | < 0.0001 | 1.06 (1.04, 1.08) | < 0.0001 |
SLEDAI-2K¶ | 1.03 (1.01, 1.06) | 0.01 | 1.03 (1.01, 1.06) | 0.01 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 | 1.09 (1.05, 1.13) | < 0.0001 |
Elevated cholesterolζ | 1.42 (0.67, 3.00) | 0.36 | 1.40 (0.66, 2.96) | 0.38 | 1.70 (1.05, 2.74) | 0.03 | 1.70 (1.06, 2.75) | 0.03 | 1.69 (1.04, 2.73) | 0.03 | 1.86 (1.16, 2.99) | 0.01 |
Corticosteroidsβ | 2.81 (1.16, 6.80) | 0.02 | 2.74 (1.13, 6.63) | 0.03 | 1.75 (0.99, 3.10) | 0.054 | 1.76 (1.00, 3.11) | 0.051 | 1.72 (0.97, 3.03) | 0.06 | 1.81 (1.02, 3.19) | 0.04 |
Antimalarials§ | 0.57 (0.36, 0.90) | 0.02 | 0.59 (0.37, 0.94) | 0.03 | 0.95 (0.60, 1.51) | 0.82 | 0.96 (0.60, 1.53) | 0.85 | 0.96 (0.60, 1.53) | 0.85 | 0.92 (0.58, 1.47) | 0.73 |
Immunosuppressives¥ | 0.91 (0.58, 1.43) | 0.68 | 0.89 (0.56, 1.41) | 0.61 | 1.45 (0.89, 2.34) | 0.13 | 1.37 (0.85, 2.23) | 0.20 | 1.38 (0.85, 2.23) | 0.20 | 1.43 (0.88, 2.32) | 0.14 |