Hydroxychloroquine and Cardiovascular Events in Patients With Systemic Lupus Erythematosus

Area of Science:

• Rheumatology
• Cardiology
• Epidemiology

Background:

• Systemic lupus erythematosus (SLE) significantly increases the risk of early cardiovascular (CV) events.
• Hydroxychloroquine is hypothesized to mitigate CV risk factors in SLE patients, but its direct protective role against arterial events requires confirmation.

Purpose of the Study:

• To investigate the association between hydroxychloroquine use and the risk of myocardial infarction (MI), stroke, and other thromboembolic events (OTEs) in patients with SLE.

Main Methods:

• A nested case-control study was conducted using the French National Healthcare Database (SNDS) from 2010-2020.
• The study included a cohort of 52,883 SLE patients, with cases experiencing CV events and controls matched for various factors.
• Hydroxychloroquine exposure was categorized as current, remote, or none, and analyzed using multivariable conditional logistic regression.

Main Results:

• Current hydroxychloroquine use was associated with significantly lower odds of composite CV events (OR, 0.63; 95% CI, 0.57-0.69).
• Specific reductions in odds were observed for MI (OR, 0.72), stroke (OR, 0.69), and OTEs (OR, 0.58) compared to no recent exposure.
• Remote hydroxychloroquine use did not show a significant association with reduced CV outcomes.

Conclusions:

• Current hydroxychloroquine use demonstrates a protective association against cardiovascular events in patients with SLE.
• The findings underscore the importance of continuous hydroxychloroquine treatment for mitigating CV risk in this population.