Study reveals that most lupus patients are at risk for ischemic heart disease 6 to 9 years after diagnosis

According to a recent finding reported in BMC Rheumatology, patients with systemic lupus erythematosus (SLE) have a greater risk of developing ischemic heart disease (IHD), with the greatest risk occurring 6 to 9 years following their initial diagnosis. 

Dr. Chen and colleagues conducted the retrospective cohort analysis using data from the National Health Insurance Research Database of Taiwan, covering 12 years (2006 to 2018), to examine the connection between IHD, lupus, and exposure to air pollution. The study comprised of 4,842 subjects with first-diagnosed SLE (SLE group) and 19,368 participants without SLE (control group). The risk of IHD peaked between the 6th and 9th year in the SLE group, and it was considerably greater in the SLE group than in the control group by the end of 2018. The SLE group’s hazard ratio of incident IHD was 2.42 times that of the control group. Sex, age, CO, NO2, particulate matter 10 (PM10), and PM2.5 all showed significant connections with the risk of developing IHD, with PM10 exposure showing the highest risk of IHD occurrence. 

A 2021 case-control study has denoted a three to four-fold increased risk of cardiovascular events and mortality in individuals with mild SLE (n=99) who have had it for more than 10 years. Although plaques were more common in patients included in this study, baseline carotid intima-media thickness (cIMT) did not differ across the study and control groups (P =0.068). About 12 patients and 4 controls obtained the outcome in 10.1 (9.8-10.2) years (P =0.022). In comparison to the controls, the risk of an unfavorable outcome in patients increased three to four times, depending on the patient’s age, gender, baseline BMI, waist circumference, C-reactive protein, total cholesterol, high-density lipoprotein, low-density lipoprotein, dyslipidemia, cIMT, and carotid plaque presence. Higher Systemic Lupus International Collaborating Clinics score, SLE-antiphospholipid syndrome, and cIMT in patients were all linked to an elevated likelihood of a negative outcome, with respective hazard ratios of 1.66 and 9.08, respectively.  

The study findings highlight an increased risk of IHD and cardiovascular events in individuals with SLE, particularly during the 6th to 9th years and beyond 10 years following diagnosis. It is crucial to implement enhanced heart health examinations and a health education program for SLE patients before the 6th year following their diagnosis. This proactive approach can potentially help in the early detection and management of cardiovascular risks in SLE patients, ultimately leading to better health outcomes and improved quality of life. 

References 

  1. Chen PY, Tsan YT, Yang CT, Lee YM, Chen LL, Ho WC, et al. Prediction of risk of ischemic heart disease in first-diagnosed systemic lupus erythematosus patients in taiwan: is air pollution exposure a risk factor?. BMC rheumatology. 2023 Jun 8;7(1):14. 
  2. Ajeganova S, Hafstrom I, Frostegard J. Patients with SLE have higher risk of cardiovascular events and mortality in comparison with controls with the same levels of traditional risk factors and intima-media measures, which is related to accumulated disease damage and antiphospholipid syndrome: a case–control study over 10 years. Lupus Science & Medicine. 2021 Feb 1;8(1):e000454. 

 

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