Patients with systemic lupus erythematosus in remission for five or more years are at a lower risk of cardiovascular disease than those with shorter remission times or who fail to enter remission, a retrospective study reports.
The study, “Prolonged remission is associated with a reduced risk of cardiovascular disease in patients with systemic lupus erythematosus: a GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study,” was published in Clinical Rheumatology.
SLE, the most prevalent form of lupus, is a chronic autoimmune disease characterized by a series of physical, behavioral, and psychological symptoms, including tissue inflammation, skin rash, pain, fatigue, depression, and impaired cognition.
Prolonged remission — defined as five consecutive years with no disease activity — is usually associated with lesser tissue and organ damage.
But while the incidence of cardiovascular disease (CVD) — the main cause of death among SLE patients — seems to be directly correlated with disease activity, the relationship, if any, between prolonged remission and CVD in SLE patients is not known.
Investigators analyzed clinical records from 294 SLE patients, followed for at least five years and a mean of nine years, who had not experienced any symptoms of CVD at the time they entered the study.
The incidence of a first CVD event was compared among patients who reached prolonged remission (131 patients at a mean of nine years) and those with shorter remissions or no remission. Patients in prolonged remission were then divided into three subgroups: those who achieved complete remission (32.8%); those in clinical off-corticosteroids remission (offCR; 22.9%); and those in clinical on-corticosteroids remission (onCR; 44.3%).
Over the mean nine years of follow-up, a total of 24 CVD events were recorded.
Prolonged remission patients lived longer without experiencing any CVD event than those in the other overall groups. These patients also, regardless of the type of remission reached, shared identical CVD outcomes.
Further analysis revealed that while prolonged remission and hydroxychloroquine therapy seemed to decrease the chances of developing CVD, arterial hypertension and antiphospholipid positivity (production of autoantibodies that increase the risk of blood clots and thrombosis) significantly increases the likelihood of CVD events.
Altogether, these findings indicate that prolonged remission is associated with better CVD outcomes among SLE patients, and could be considered as a target treatment goal.
“We demonstrated that PR [prolonged remission], as defined by clinical, serological, and therapeutic criteria, is associated with a lower risk of new occurrence of a CVD,” the researchers concluded. “Our data may indicate that a continuous period of remission is more favorable on CV [cardiovascular] outcome than the sum of short periods combined with flares.”