Rheumatology Advance Access originally published online on May 29, 2008
Rheumatology 2008 47(7):1093-1096; doi:10.1093/rheumatology/ken208
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Angiotensin-converting enzyme inhibitors delay the occurrence of renal involvement and are associated with a decreased risk of disease activity in patients with systemic lupus erythematosus—results from LUMINA (LIX): a multiethnic US cohort
1Department of Medicine, Division of Clinical Immunology and Rheumatology, 2Department of Epidemiology, 3Department of Surgery, Section of Trauma, Burns, and Critical Care, Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, AL, 4Department of Medicine, Division of Rheumatology, The University of Puerto Rico Medical Sciences Campus, San Juan, PR and 5Department of Medicine, Division of Rheumatology, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Correspondence to: G. S. Alarcón, 830 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3408, USA. E-mail: graciela.alarcon{at}ccc.uab.edu
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Abstract |
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Objective. To examine if angiotensin-converting enzyme (ACE) inhibitor use delays the occurrence of renal involvement and decreases the risk of disease activity in SLE patients.
Methods. SLE patients (Hispanics, African Americans and Caucasians) from the lupus in minorities: nature vs nurture (LUMINA) cohort were studied. Renal involvement was defined as ACR criterion and/or biopsy-proven lupus nephritis. Time-to-renal involvement was examined by univariable and multivariable Cox proportional hazards regression analyses. Disease activity was examined with a case-crossover design and a conditional logistic regression model; in the case intervals, a decrease in the SLAM-R score 
4 points occurred but not in the control intervals.
Results. Eighty of 378 patients (21%) were ACE inhibitor users; 298 (79%) were not. The probability of renal involvement free-survival at 10 yrs was 88.1% for users and 75.4% for non-users (P = 0.0099, log rank test). Users developed persistent proteinuria and/or biopsy-proven lupus nephritis (7.1%) less frequently than non-users (22.9%), P = 0.016. By multivariable Cox proportional hazards regression analyses, ACE inhibitors use [hazard ratio (HR) 0.27; 95% CI 0.09, 0.78] was associated with a longer time-to-renal involvement occurrence whereas African American ethnicity (HR 3.31; 95% CI 1.44, 7.61) was with a shorter time. ACE inhibitor use (54/288 case and 254/1148 control intervals) was also associated with a decreased risk of disease activity (HR 0.56; 95% CI 0.34, 0.94).
Conclusions. ACE inhibitor use delays the development of renal involvement and associates with a decreased risk of disease activity in SLE; corroboration of these findings in other lupus cohorts is desirable before practice recommendations are formulated.
KEY WORDS: Systemic lupus erythematosus, Lupus in minorities: nature vs nurture, ACE inhibitors, Renal, Disease activity
Submitted 12 February 2008;
revised version accepted 18 April 2008.
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