Mortality and Cardiovascular Burden of Systemic Lupus Erythematosus in a US Population-based Cohort

Abstract

Objective To examine the mortality and cardiovascular disease (CVD) burden among a population-based cohort of patients with systemic lupus erythematosus (SLE) with previously described late mean onset and low rates of organ-threatening disease. Methods This retrospective population-based cohort study investigated incident cases of SLE diagnosed from 1991–2008 and followed through March 2009 to examine rates of death and CVD events: myocardial infarction, stroke, or congestive heart failure hospitalization. Cases were identified using the 1997 update of 1982 American College of Rheumatology SLE criteria. Searches included electronic records, chart audits, and state death matches, with physician review. Age and sex-matched population comparisons facilitated relative event rate calculations. Results 70 incident SLE cases had late mean onset (52 years), with an incidence of 5 cases per 100,000/year. Matched comparisons showed similar baseline rates of hypertension, hyperlipidemia, and diabetes. However, SLE patients experienced more CVD in the 2 years preceding SLE diagnosis, odds ratio 3.8 (95% CI 1.8, 8.0). The estimated 10-year mortality rates were 26% for SLE subjects versus 19% for comparisons, hazard ratio (HR) 2.1, p<0.01. Adjusted for prior CVD, SLE cases still demonstrated increased hazards of mortality (HR 1.9, p=0.01) and CVD event or death (HR 1.8, p=0.01). Conclusion This incident SLE cohort demonstrated approximately doubled mortality and CVD event hazards compared to age and sex-matched comparisons, even after accounting for higher CVD events in the 2 years preceding SLE diagnosis. This raises future research questions regarding delayed lupus diagnosis versus accelerated CVD prior to SLE, particularly in older-onset SLE.

Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review

“…For patients with SLE, mortality from cardiovascular disease has continued to increase, despite improvements in mortality previously seen for patients with active SLE. The risk of death and cardiac events has doubled, with increases seen even early in the disease [52,53]. Young women with SLE between the age of 35-44 are 50 times more likely to have an MI than age matched controls [54].…”

Características clínicas y comorbilidades de pacientes con lupus eritematoso sistémico en niños y adultos

“…11,13,34 La vasculitis en el LES varía del 11 al 20%. Las vasculitis viscerales pueden evolucionar a la gravedad y conducir a la muerte al causar lesiones isquémicas en cerebro, corazón o intestinos, por mencionar algunos.…”

“…Se hizo el cálculo de frecuencias y porcentajes, así como pruebas de hipótesis para encontrar asociaciones significativas entre el grupo etario de los pacientes y las entidades clínicas reportadas empleando la prueba de c 2 y, en caso de ser necesaria, cuando en alguna de las categorías el número de pacientes fuera inferior a cinco, se utilizó la prueba exacta de Fisher. Además, para las principales manifestaciones clínicas que se asociaron con la mortalidad de los pacientes con LES [6][7][8][9][10][11][12][13] se obtuvieron las razones de momios (RM) y sus respectivos intervalos de confianza al 95% para conocer el riesgo en los niños para padecer comorbilidades, comparados con el grupo de adultos.…”

Evidence-based treatment of systemic lupus erythematosus and its complications

“…[9] Traditional Framingham CV risk factors do not fully explain the extent of the risk, as inflam matory and prothrombotic mechanisms underlie this premature atherosclerosis. Encouragingly, the CV risk may be reduced by regular exercise, statin therapy and possibly lowdose aspirin for any patient with ≥1 traditional risk factors for atherosclerotic disease, or with antiphospholipid antibodies.…”