OP0198 Association between Cardiovascular Disease and Main Cause of Death from Cardiovascular Causes with Maternal-Placental Syndrome in Swedish Women with Systemic Lupus Erythematosus – A Population-Based Retrospective Study
Authors: M.C. Soh, C. Nelson-Piercy, F. Dib, L. McCowan, M. Westgren, D. Pasupathy
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Young women with systemic lupus erythematosus (SLE) have a higher risk of cardiovascular disease and death from cardiovascular causes (CVDD) even in the absence cardiovascular risk factors.<sup>1</sup> Women with SLE are at greater risk of pregnancy complications from placental insufficiency as a result of vasculopathy that manifests clinically as maternal-placental syndrome (MPS).<sup>2,3</sup> In unselected populations, the risk of CVDD is increased two-fold in women with previous history of MPS.<sup>4</sup> This could be shared pathophysiological processes between MPS and future CVDD that have been unmasked by the stress of pregnancy, or pre-existing cardiac risk factors for more generalised vascular disease that are present in women who develop MPS.<sup>5</sup> However, it is not known if MPS increases the risk of future CVDD in the young women with SLE. <h3>Objectives</h3> To determine the future risk of CVDD in women with SLE who have had pregnancies complicated by MPS. <h3>Methods</h3> Using linked population registries from Sweden, parous women with SLE were identified between 1973-2011. The outcomes of interest were CVDD, this encompassed main cause of death or disease from coronary artery disease (CAD), stroke and peripheral vascular disease (PVD). MPS was defined as pre-eclampsia, small for gestational age (SGA), placental abruption or intrauterine death. Multivariate analysis was performed adjusting for duration of SLE and co-morbidities that were renal disease, hypertension and diabetes. <h3>Results</h3> There were 7,410 pregnancies in 3,977 women. Prevalence of cardiovascular disease was 9.0% (n=359) of which CAD accounted for 51.8% (n=186), stroke 43.5% (n=156) and PVD 18.9% (n=68). The median age of onset of cardiovascular disease was 50 years (IQR 41-57). There were 47 women with cardiovascular pathology documented as the main cause of death; CAD accounted for 66.5% (n=31), stroke 23.4% (n=11) and PVD 4.3% (n=2). Median age of death from cardiovascular causes was 53 years (IQR 46-58). Overall, the median age of CVDD was 50 years (IQR 41-57). The risk of CVDD was not significantly increased in those with a history of MPS (Adjusted OR 1.2; 95%CI 0.9-1.5), but there was a two-fold increase risk of CVDD in women with history of intrauterine deaths (Adjusted OR 1.9; 95%CI 1.1-3.3). These associations were independent of SLE disease status at the time of pregnancy (p&gt;0.05). <h3>Conclusions</h3> Unlike reports from the general population, the risk of CVDD in women with SLE was not affected by MPS in pregnancy unless intrauterine death was present. <h3>References</h3> Urowitz M, et al. J Rheumatol 2007;34:70-75. Clowse M, et al. Am J Obstet Gynecol. 2008;199:127e1.6. Magid MS, et al. Am J O&amp;G 1998;179: 226-34. Bellamy, L, et al. BMJ 2007;335:974. Magnussen EB, et al. BMJ 2007;335:978. <h3>Acknowledgements</h3> The Rose-Hellaby Medical Trust Scholarship and the APLAR Fellowship grant for the support of Dr. May Ching Soh. Ms. Alexandra Gillett for data linkage of the databases. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.3286