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Atherosclerotic Vascular Events in Systemic Lupus Erythematosus: An Evolving Story

Murray B Urowitz1,2, Jiandong Su3,4, Dafna D Gladman3,4

  • 1From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Disease, Toronto Western Hospital, Toronto, Ontario, Canada. m.urowitz@utoronto.ca.

The Journal of Rheumatology
|February 3, 2019
PubMed

Insights

Early management of cardiovascular risk factors and systemic lupus erythematosus (SLE) significantly reduced atherosclerotic vascular events (AVE) in recent decades. This improved SLE patient outcomes by lowering AVE incidence.

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Epidemiology

Background:

  • Atherosclerotic vascular events (AVE) are a primary cause of mortality and morbidity in patients with systemic lupus erythematosus (SLE).
  • Managing traditional cardiovascular risk factors alongside SLE disease activity is crucial for improving patient prognosis.

Purpose of the Study:

  • To evaluate the impact of early recognition and treatment of cardiovascular risk factors and SLE on the incidence of AVE.
  • To compare AVE burden in SLE patients across different eras of clinical management.

Main Methods:

  • A retrospective cohort study comparing two groups of SLE patients: Cohort 1 (1975-1987) and Cohort 2 (1999-2011).
  • Assessment of SLE disease activity, therapy, and traditional risk factors (hypertension, hypercholesterolemia, hyperglycemia, smoking).
  • Analysis included outcome rates per 100 person-years, Kaplan-Meier curves, and Cox models with inverse probability weighting.

Main Results:

  • The incidence of AVE decreased from 11% in Cohort 1 to 3.8% in Cohort 2.
  • The rate of AVE per 100 person-years dropped from 1.8 in Cohort 1 to 0.44 in Cohort 2 (p < 0.0001).
  • Cohort 2 demonstrated better control of risk factors and SLE disease activity, with a 60% reduction in AVE risk.

Conclusions:

  • The incidence of AVE in SLE has declined in the modern era.
  • Effective management of traditional cardiovascular risk factors and SLE disease is key to reducing AVE burden in SLE patients.
Abstract

Keywords:
ARTERIOSCLEROSISRISK FACTORSSYSTEMIC LUPUS ERYTHEMATOSUS

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