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Incidence and risk of heart failure in systemic lupus erythematosus
Chang H Kim1,2, Sadeer G Al-Kindi1,2, Bochra Jandali1,2
1Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Insights
Patients with systemic lupus erythematosus (SLE) have a significantly higher risk of heart failure (HF). This study found SLE is an independent predictor of HF, especially in younger males, and renal involvement exacerbates risk.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Epidemiology
Background:
- Systemic lupus erythematosus (SLE) is associated with increased cardiovascular risk factors.
- The specific association between SLE and heart failure (HF) incidence and risk is not well-defined.
Purpose of the Study:
- To investigate the incidence and risk of heart failure (HF) in patients with systemic lupus erythematosus (SLE).
Main Methods:
- Retrospective cohort analysis of aggregated electronic medical record data from 26 major US healthcare systems (1999-present).
- Demographic and regression analyses were used to assess the impact of SLE on HF incidence.
Main Results:
- Heart failure (HF) incidence was significantly higher in patients with SLE (0.97%) compared to controls (0.22%), with a relative risk (RR) of 4.6.
- Systemic lupus erythematosus (SLE) was an independent predictor of HF (adjusted OR: 3.17).
- The risk of HF was highest in young males with SLE, and renal involvement correlated with earlier and higher HF incidence.
Conclusions:
- Patients with SLE face a substantially elevated risk of developing heart failure (HF) and possess a poorer cardiovascular risk profile.
- Further prospective studies are warranted to confirm these findings regarding SLE and HF risk.
Background:
Although case series suggest a higher burden of cardiovascular risk factors in patients with systemic lupus erythematosus (SLE) compared with the general population, the association between SLE and heart failure (HF) remains undefined. We sought to investigate the incidence and risk of HF in patients with SLE.
Methods:
In April 2016, we performed a retrospective cohort analysis using the Explorys platform, which provides aggregated electronic medical record data from 26 major integrated healthcare systems across the USA from 1999 to present. Demographic and regression analyses were performed to assess the impact of SLE on HF incidence.
Results:
Among 45 284 540 individuals in the database, we identified 95 400 (0.21%) with SLE and 98 900 (0.22%) with a new diagnosis of HF between May 2015 and April 2016. HF incidence was markedly higher in the SLE group compared with controls (0.97% vs 0.22%, relative risk (RR): 4.6 (95% CI 4.3 to 4.9)), as were other cardiovascular risk factors. In regression analysis, SLE was an independent predictor of HF (adjusted OR: 3.17 (2.63 to 3.83), p<0.0001). RR of HF was highest in young males with SLE (65.2 (35.3 to 120.5) for age 20-24), with an overall trend of increasing absolute risk but decreasing RR with advancing age in both sexes. Renal involvement in SLE correlated with earlier and higher incidence of HF.
Conclusions:
The findings of this study suggest that patients with SLE have significantly higher risk of developing HF and a worse cardiovascular risk profile compared with the general population. These results need to be confirmed by prospective studies.
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