Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study

Abstract

Systemic lupus erythematosus (SLE) is a well-known cardiovascular risk factor. Less is known about cutaneous lupus erythematosus (CLE) and the risk of developing cardiovascular disease (CVD). Therefore, we investigated the risk of mortality and adverse cardiovascular events in patients diagnosed with SLE and CLE. We conducted a cohort study of the entire Danish population aged ≥ 18 and ≤ 100 years, followed from 1997 to 2011 by individual-level linkage of nationwide registries. Multivariable adjusted Cox regression models were used to estimate the hazard ratios (HRs) for a composite cardiovascular endpoint and all-cause mortality, for patients with SLE and CLE. A total of 3282 patients with CLE and 3747 patients with SLE were identified and compared with 5,513,739 controls. The overall HR for the composite CVD endpoint was 1.31 (95% CI 1.16-1.49) for CLE and 2.05 (95% CI 1.15-3.44) for SLE. The corresponding HRs for all-cause mortality were 1.32 (95% CI 1.20-1.45) for CLE and 2.21 (95% CI 2.03-2.41) for SLE. CLE and SLE were associated with a significantly increased risk of CVD and all-cause mortality. Local and chronic inflammation may be the driver of low-grade systemic inflammation.

Increased risk of depression in patients with cutaneous lupus erythematosus and systemic lupus erythematosus: a Danish nationwide cohort study

“…The reason for the increased risk of depression in patients with SLE remains unclear. This is probably due to both direct and indirect consequences of the disease; a direct consequence of the systemic inflammation and an indirect consequence of the psychological burden of having and coping with a chronic disease . Previous studies have shown that depression is associated with inflammation.…”

High Prevalence of Metabolic Syndrome in Patients with Discoid Lupus Erythematosus: A Cross-Sectional, Case-Control Study

“…Furthermore, especially in recent years, evaluating the significant accompanying comorbidities in terms of morbidity and mortality such as CVDs and cerebrovascular accidents (which are more frequent in SLE) has been highlighted in skin-restricted lupus patients [4–6]. However, it is unknown that whether CLE is associated with risk of MetS or not.…”

“…Recently, in a large case-control study performed by Hesselvig et al in Danish population, significantly increased risk of CVDs and all-cause mortality were observed both in CLE and in SLE patients including inpatients and outpatients, as being higher in SLE, and these risks were found more significant in the patients with an age of ≤50 years [4]. In a Swedish study, Zöller et al examined whether there was an association between hospital admission for CLE and subsequent risk of hospitalization for coronary heart disease.…”

“…Local and chronic inflammation in DLE patients may be the driver of low-grade systemic inflammation [2–4]. Thus, this inflammation may have thought of to be the connecting link between DLE and MetS.…”

“…Although inflammatory load is lower in the patients with LE having only skin involvement; when pathogenesis is considered, it can be thought that some comorbidities accompanying SLE can also be seen in CLE patients. Hence, in the recent studies, it has been shown that some disorders such as cardiovascular diseases (CVD) and cerebrovascular accidents that are mostly associated with SLE are higher in CLE patients when compared to the control group [4–6]. Furthermore, it has been determined that metabolic syndrome (MetS) components, such as central obesity, hypertension (HT), dyslipidemia, and glucose intolerance that are known to be the risk factors in the occurrence of such diseases, are frequent in SLE patients and the presence of MetS accompanying SLE has been found to have higher ratios (varying from 17% to 40%) when compared to the general population [7–16].…”