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Major adverse cardiovascular events and mortality in systemic lupus erythematosus patients after successful delivery:
Lung-Sheng Wu1, Chao-Hsiun Tang, Yu-Sheng Lin
1Division of Cardiology, Department of Internal Medicine (L-SW, Y-SL, C-PL, P-HC), Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan; School of Health Care Administration (C-HT, S-TH), Taipei Medical University, Taipei, Taiwan; Gynecology Research Center (C-HT), Taipei Medical University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine (H-LH), College of Medicine, and Department of Obstetrics and Gynecology (H-LH), National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Genetics (H-LH), National Taiwan University Hospital, Taipei, Taiwan; and Division of Rheumatology, Allergy, and Immunology (S-FL), Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Background:
Limited data exist regarding the incidence rate and hazard ratios (HRs) of major adverse cardiovascular events and mortality in the successful-delivery women with or without systemic lupus erythematosus.
Methods:
A retrospective, population-based cohort study was performed on 1,132,089 parturients from 1999 to 2003. The Kaplan-Meier method and the log-rank test were used to examine the effect of systemic lupus erythematosus on the incidence of major adverse cardiovascular events and mortality. Cox-proportional hazard regression modeling was used to determine the adjusted HRs of systemic lupus erythematosus on the risk of major adverse cardiovascular events and mortality among successful-delivery women.
Results:
Systemic lupus erythematosus group has the highest risk for major adverse cardiovascular events and mortality. The incidence rate of major adverse cardiovascular events and all-causes mortality among lupus women was 194.67 and 438.82 per 100,000 patients per year, respectively. Lupus women had higher incidence rates of major adverse cardiovascular events, including myocardial infarction, (HR, 54.43; confidence interval [CI], 16.04-184.78; P < 0.0001), heart failure (HR, 11.10; CI, 2.71-45.52; P < 0.0001), percutaneous coronary intervention (HR, 228.32; CI, 43.34-1203.00; P < 0.0001), stroke (HR, 8.02; CI, 3.79-16.99; P < 0.0001) and maternal death (HR, 11.68; CI, 7.97-17.10; P < 0.0001).
Conclusions:
Although major adverse cardiovascular events and mortality are rare events in women of reproductive age, the incidence rates have increased approximately 10-fold among lupus women with successful delivery. Clinicians should note the possibility of persisting major adverse cardiovascular events and death in young women with lupus and successful delivery.
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