Association Between Cutaneous Lupus Erythematosus and Atherosclerotic Cardiovascular Disease: A Systematic Review

Cutaneous lupus erythematosus (CLE) is an autoimmune skin disorder increasingly recognized to have systemic effects, including possible links to atherosclerotic cardiovascular disease (ASCVD). However, the strength and pattern of this association remain uncertain.

To evaluate and assess available evidence on ASCVD risk in CLE, identify patterns across study designs and populations, and highlight research gaps requiring further study.

A systematic search of PubMed, Scopus, and Web of Science was conducted up to July 2025, following PRISMA 2020 guidelines (PROSPERO ID: CRD420251156382). Eligible studies included adult CLE populations reporting ASCVD outcomes. Data extraction and risk-of-bias assessment were independently performed using the Newcastle-Ottawa Scale and the AXIS tool.

Six observational studies met the inclusion criteria, including population-based cohorts, hospital datasets, and case-control analyses. Across designs, CLE was consistently associated with elevated ASCVD risk, particularly stroke and thromboembolic events. Large registry-based studies showed significant associations even after adjustment for traditional risk factors, suggesting CLE-specific inflammatory mechanisms. Smaller cohorts highlighted high comorbidity burdens and subtype differences, particularly a stronger signal in discoid lupus.

Evidence indicates that CLE is linked to increased ASCVD risk, especially cerebrovascular and thromboembolic outcomes. Standardized definitions and longitudinal studies are needed to clarify subtype-specific risks and inform prevention strategies.