Lupus Patients See Greater Heart Disease-Related Risks Over Time, Study Suggests

The rate of cardiovascular events in lupus patients increased during the second half of a 15-year period, a long-term study found. Cardiovascular events included angina (chest pain), fatal or nonfatal acute myocardial infarction (MI), transient ischemic attack (“mini-stroke”), fatal and nonfatal stroke, and cardiovascular (CV) death.

The study, titled “Evolution of Risk Factors for Atherosclerotic Cardiovascular Events in Systemic Lupus Erythematosus: A Longterm Prospective Study,” was published in The Journal of Rheumatology.

In a previous study, the authors had shown that SLE patients had a higher rate of coronary artery disease (CAD), the most common type of heart disease, during the first eight years after their diagnoses (2000-2007), compared to healthy control subjects. The risk factors in the SLE group were directly linked to the diagnosis of SLE, along with older age and high triglyceride (fat) levels in the blood.

This study looked at the rates of cardiovascular events in the same SLE patients in the second half of the 15-year period (2008-2015).

Researchers found higher rates of cardiovascular events in SLE patients during the seven years of the study’s second phase than in the first phase — 11.4% versus 7.1%, respectively. However, the risk factors for cardiovascular events were not directly related to specific SLE factors, as identified in the first phase of the study. On the contrary, they were the same factors associated with heart disease in the general population, especially age, arterial hypertension, and diabetes mellitus, or high blood sugar.

Coronary arterial disease was more common in SLE than in controls (32/210 or 15.2% versus 5/138 or 3.6%, respectively) during the entire 15-year period.

The authors point out that while arterial hypertension and diabetes are not related to symptoms of SLE, they were often caused by prednisone treatment given to the SLE patients.

Also, while no cardiovascular events-related deaths occurred between 2000 and 2007, during the study’s second phase (2008-2015), 4.8% of patients with SLE died (10 patients out of 210).

The authors call for monitoring of the usual risk factors for cardiovascular disease in lupus patients since they are surviving longer and their SLE is better-controlled.

Overall, “SLE-related risk factors drive accelerated atherosclerosis in the early stages of the disease while traditional risk factors, partially attributed to increased cumulative prednisone dose, significantly affect CV risk in later stages,” the authors wrote.

“As patients survive longer and their disease is better controlled, continued vigilance in monitoring and treating CV [cardiovascular] risk factors must remain a priority,” the study concluded.