Systemic lupus erythematosus in a multiethnic US Cohort (LUMINA).: XXX:: association between C-reactive protein (CRP) gene polymorphisms and vascular events

Objectives. To determine if a polymorphic GT(n) repeat in the intron of the C-reactive protein (CRP) gene associates with occurrence of vascular arterial events in systemic lupus erythematosus (SLE). Methods. We performed a nested case-control study on the LUMINA cohort of 546 Hispanic, African-American and Caucasian SLE patients. Twenty-five patients who developed vascular arterial events (i.e. myocardial infarction, angina, coronary artery bypass graft surgery, stroke, claudication, gangrene or significant tissue loss and/or arterial peripheral thrombosis) after enrolment were selected as cases and 32 ethnically matched patients with no previous vascular arterial events served as controls. Their CRP gene GT(n) polymorphism and plasma CRP was determined. Results. Patients with vascular events had more severe SLE and were more likely to have plasma CRP in the highest quintile of measured values. The overall distribution of GT(n) alleles for patients with vascular events had a greater number of the GT(20) variant compared with controls [26.0% of alleles (13/50) vs 15.6% (10/64)]. This greater number of GT(20) in patients with vascular events was observed for African-Americans [29.2% (7/24) vs 21.0% (8/38)] and Hispanics [33.0% (4/12) vs 0% (0/16)] but not for Caucasians [14.3% (2/14) vs 20.0% (2/10)]. For African-Americans and Hispanics combined (45 patients), the frequency of GT(20) in those with vascular events (30.6%, 11/36) was significantly higher than in those without them (14.8%, 8/54) (P < 0.05, one-tailed test for difference in proportions). When patients were categorized according to the number of GT(20) alleles they carried (thus GT(20)/GT(20), GT(20)/GT(x) or GT(x)/GT(x), where x is any allele other than GT(20)), for both African-Americans and Hispanics the likelihood of vascular arterial events increased in proportion with the GT(20) dose, and all GT(20)-homozygous patients developed vascular arterial events. Conclusions. The CRP GT(20) variant is more likely to occur in African-American and Hispanic SLE patients than in Caucasian ones, and SLE patients carrying the GT(20) allele are more likely to develop vascular arterial events.