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Optimizing Hydroxychloroquine Blood Levels and Long-Term Hydroxychloroquine Intake Could Lower ASCVD Risk and Prevent
Shivani Garg1, Murray Urowitz2, Charlie Dentz3
1Yale School of Medicine.
Arthritis Care & Research
|August 3, 2026
Summary
Low hydroxychloroquine (HCQ) levels and poor adherence increase atherosclerotic cardiovascular disease (ASCVD) risk in systemic lupus erythematosus (SLE) patients. Maintaining therapeutic HCQ levels and adherence is crucial for better cardiovascular outcomes.
Area of Science:
- Rheumatology
- Cardiology
- Pharmacology
Background:
- Hydroxychloroquine (HCQ) is a key treatment for systemic lupus erythematosus (SLE).
- HCQ offers protection against atherosclerotic cardiovascular disease (ASCVD) in SLE patients.
- The impact of longitudinal changes in HCQ blood levels and long-term intake on ASCVD risk is not well understood.
Purpose of the Study:
- To evaluate the relationship between HCQ blood levels, long-term intake patterns, and estimated ASCVD risk in SLE patients.
- To assess changes in HCQ exposure and ASCVD risk over a one-year period.
Main Methods:
- Prospective longitudinal study of 248 adults with SLE on HCQ.
- Measured HCQ blood levels (recent exposure) and proportion of days covered (PDC, long-term intake).
- Calculated 10-year ASCVD risk using the PREVENT calculator at baseline and 1-year follow-up.
Main Results:
- Patients with very low HCQ levels (<200 ng/mL) and low PDC (<80%) had significantly higher baseline ASCVD risk (+2.1%, mean 6.6%).
- Those remaining in or transitioning to low-exposure categories had the highest ASCVD risk at follow-up (5.7%).
Conclusions:
- Low long-term HCQ intake and very low HCQ blood levels are associated with increased ASCVD risk in SLE patients.
- Interventions to improve HCQ adherence and maintain therapeutic levels may improve cardiovascular outcomes.
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