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2.  Racial Disparities for Age at Time of Cardiovascular Events and Cardiovascular Death in SLE Patients 
Arthritis and rheumatism  2010;62(9):2767-2775.
The aim of this study was to determine if there are racial disparities in regard to the age at which SLE patients experience CVD and CVD associated death.
Using the 2003–2006 National Inpatient Sample, we calculated the age difference between SLE patients and their race and gender-matched controls at the time of hospitalization for a cardiovascular (CVD) event and for CVD-associated death. In addition, we also calculated the age difference for the same outcomes between White SLE patients and gender-matched controls for each minority group.
The mean age difference at the time of CVD event between women with and without SLE was 10.5 years. All age differences between women with SLE (n=3,625) and women without SLE admitted for CVD were significant (p<0.0001). Black women were the youngest female SLE racial group to be admitted with CVD (53.9 years) and have a CVD associated inhospital mortality (52.8 years; n=218). Black SLE women were 19.8 years younger than race and gender-matched controls at the time of CVD associated death. Admission trends for CVD were reversed for Black women such that the highest proportions of these patients were admitted before age 55 and then steadily decreased across age categories. There were 805 men with SLE admitted with a CVD event, with Black and Hispanic groups being the youngest.
There are significant racial disparities with regard to age at the time of hospital admission for CVD events and a CVD-related hospitalization resulting in death in patients with SLE.
PMCID: PMC2946465  PMID: 20506536
3.  The Relationship Between Race, Cigarette Smoking and Carotid Intimal Medial Thickness in Systemic Lupus 
Lupus  2009;18(14):1289-1297.
Racial differences are known to account for a higher incidence of systemic lupus erythematosus (SLE), as well as increased disease severity and mortality. The purpose of this study was to determine if there are any race-specific risk factors that affect measures of subclinical atherosclerosis in SLE patients.
Traditional and SLE-related cardiovascular disease (CVD) risk factors were assessed in 106 female SLE patients. Carotid medial intimal medial thickness (mIMT) and coronary artery calcification (CAC) were measured on all subjects. Differences were evaluated between races for all clinical, serologic, and CVD risk factors and the racial interactions with all covariables. Outcomes included mIMT and CAC.
There were no significant differences between races with regard to mIMT or CAC. Significant covariables in the final model for mIMT included age, triglycerides, glucose, and race-age and race-smoking interactions. A prediction model with fixed significant covariables demonstrated that Black subjects with a smoking history had a significantly higher mIMT than Blacks who had never smoked, an effect not seen in Whites. There were no differences between having CAC or with the CAC scores between the races. In the final model for CAC, age and SLE disease duration were significant covariables impacting CAC.
When controlling for other significant CVD covariables and interactions, Black women, but not White, with SLE with a history of smoking have higher mIMT measurements than those who have never smoked. This is the first report documenting the race-specific effect of smoking on subclinical measures of CVD in SLE.
PMCID: PMC2804892  PMID: 19861342
lupus; cardiovascular; smoking; race
4.  Short-Term Perioperative All-Cause Mortality and Cardiovascular Events in Women with Systemic Lupus Erythematosus 
Arthritis care & research  2013;65(6):986-991.
Persons with systemic lupus erythematosus (SLE) are at increased risk of cardiovascular disease (CVD) events, but this excess CVD burden in the perioperative setting is yet to be determined. We aimed to determine the risk of perioperative short-term all-cause mortality and CVD events among women with SLE compared to those without SLE.
Methods and Results
We conducted a cross-sectional analysis of pooled hospital discharge data from years 1998 to 2002 of the Nationwide Inpatient Sample. We abstracted diseases and procedures using International Classification of Diseases, Ninth Revision (ICD-9-CM) codes. The principal procedure was categorized into either a low, intermediate, or high risk level. Survey logistic regression adjusting for potential confounders provided estimates for stratum-specific odds of adverse events in women with SLE relative to those without SLE for each procedure risk level. All-cause mortality was significantly greater among women with SLE having a low (Odds Ratio [OR] 1.54; 95% Confidence Interval [CI] 1.00-2.37) or a high risk principal procedure (OR 2.52; 95% CI 1.34-4.75) relative to women without SLE, but did not differ significantly among persons with intermediate risk procedures. Women with SLE with a low risk procedure were also more likely to experience a composite CVD event relative to women without SLE (OR 1.40; 95% CI 1.04-1.87).
Women with SLE are at increased risk for short-term perioperative adverse events. These results highlight a need for greater scrutiny during perioperative evaluation and management of women with SLE.
Significance and Innovation
The perioperative setting represents a time of heightened risk for morbidity and mortality, especially in individuals at increased risk of cardiovascular disease. Women with SLE are at increased risk of premature morbidity and mortality attributed to atherosclerotic disease. The results of our study which revealed an increased risk of adverse perioperative events in women with SLE indicates a need for greater scrutiny in perioperative clinical care also in addition to further investigation as to the non-cardiovascular causes of increased perioperative mortality observed in women with SLE.
PMCID: PMC3674177  PMID: 23213026
5.  Patient preferences and satisfaction in a multispecialty infusion center 
Direct feedback from patients about their preferred modes of medication administration has been increasingly sought by providers to develop care programs that best match patient goals. Multispecialty infusion centers generally provide care to hematology–oncology (HO) and non-HO patients in one unit, with the same nursing staff. Our staff perceived that this was dissatisfying to our non-HO patients. We assessed patient satisfaction, as well as nursing and physician perceptions of patient preference/satisfaction with our infusion center, to determine whether a separate unit should be recommended when designing our new Cancer Institute Infusion Center.
Patients and methods
A seven-question Likert scale satisfaction survey for patients, and a separate survey to assess nurses’ and physicians’ perception of patient satisfaction, were developed. The survey was administered to non-HO patients receiving infusions, doctors prescribing infusions, and nurses administering infusions. Results of the survey were compared between groups to assess differences in responses.
Responses were received from 52 non-HO patients, 18 physicians, and 13 nurses. Patients had more satisfaction, on all survey items, with the multispecialty infusion center than had been realized by physicians and nurses. Analysis demonstrated that patients were satisfied with care in a multispecialty infusion unit and were in favor of continuing their care in this combined center. Total scores of patient surveys were significantly different (P<0.001) from those of physicians and nurses, who had assumed patients would prefer to have their care in a non-HO infusion setting.
Understanding patient preferences is an important step in deciding the structure of infusion centers. Based on these survey conclusions, a combined multispecialty infusion center has been continued at our institution, thus improving quality by including patients in decision-making affecting their care.
PMCID: PMC4036814  PMID: 24876769
patient care; infusion preferences; non-oncology patients; infusion therapy
6.  Prolonged CD154 Expression on Pediatric Lupus CD4 T Cells Correlates with Increased CD154 Transcription, Increased NFAT Activity, and Glomerulonephritis 
Arthritis and rheumatism  2010;62(8):2499-2509.
To assess CD154 expression in pediatric lupus and explore a transcriptional mechanism explaining dysregulated CD154 expression.
Cell surface CD154 expression was examined, pre- and post-activation, on peripheral blood CD4 T cells from 29 children with lupus and matched controls by flow cytometry. CD154 expression was correlated with clinical features, laboratory parameters, and treatments received. Increased CD154 expression on lupus CD4 T cells was correlated with CD154 message and transcription rates by real-time RT-PCR and nuclear run-on assays, respectively. NFAT transcriptional activity and NFAT mRNA levels in lupus CD4 T cells were explored by reporter gene analysis and real-time RT-PCR, respectively.
CD154 surface protein levels were increased 1.44-fold on lupus CD4 T cells compared to controls at one day post-activation ex vivo. This increase correlated clinically with the presence of nephritis and elevated erythrocyte sedimentation rate. Increased CD154 protein also correlated with increased CD154 mRNA levels and rates of CD154 transcription, particularly at later time-points post-T cell activation. Reporter gene analyses revealed a trend for increased NFAT, but decreased AP-1 and similar NFκB, activity in lupus CD4 T cell compared to controls. Moreover, NFAT1 and, in particular, NFAT2 mRNA levels were notably increased in lupus CD4 T cells compared to controls.
Following activation, cell surface CD154 is increased on pediatric lupus CD4 T cells compared to controls, and this correlates with the presence of nephritis, increased CD154 transcription rates, and NFAT activity. These results suggest that NFAT/calcineurin inhibitors, such as tacrolimus and cyclosporine, may be beneficial in treating lupus nephritis.
PMCID: PMC2921031  PMID: 20506525

Results 1-6 (6)