Doing the medication refills today I saw a patient on a statin aged 38y. I wondered why she was taking a statin and looked for any history of CVD in the notes but found none. She does not have the classic courier risk factors of DHL i.e. diabetes or hypertension or lipidemia reaching a level high enough to justify statins. So I revised the notes again and saw that she had SLE. This led to a question in my mind. How much does SLE increase the risk of CVD disease?
Having been recently introduced to the Trip Database I used it to try and quickly search for an answer and came up with the paper whose abstract is included at the bottom. It looked at the Nurses’ Health Study and concluded that SLE doubled (relatively speaking) the risk of CVD.
Using the Pubmed link there was a free link to an editorial in one of the Arthritis Journals and this gave some further additional insight which was worth reading.
My take home points:
- CVD risk is doubled if you have SLE.
- SLE has a bimodal mortality pattern: mortlaity is raised soon after diagnosis and later on in life
- Try and minimise steroid usage because of the CVD risk.
Arthritis Rheum. 2009 Oct 15;61(10):1396-402.
Systemic lupus erythematosus and the risk of cardiovascular disease: results from the nurses’ health study.
Hak AE, Karlson EW, Feskanich D, Stampfer MJ, Costenbader KH.
Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
OBJECTIVE: Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular disease. However, prospective population-based data addressing this association have been lacking.
METHODS: We conducted a prospective cohort study among 119,332 women participating in the Nurses’ Health Study who were free of cardiovascular disease and SLE at baseline in 1976. Incident SLE was confirmed by medical record review. Cardiovascular events included fatal and nonfatal myocardial infarction, stroke, coronary artery bypass grafting, and angioplasty. The relative risk (RR) of cardiovascular events among participants with SLE as compared with those without SLE was estimated using Cox proportional hazards models.
RESULTS: Over 28 years of followup (2.9 million person-years), 8,169 cardiovascular events occurred and 148 women developed incident SLE. The mean age at SLE diagnosis was 52.6 years, and 20 participants with SLE developed a subsequent cardiovascular event. After adjusting for potential confounding factors, including age, race, cardiovascular risk factors, and medication use, the RR of a cardiovascular event in women with SLE compared with those without SLE was 2.26 (95% confidence interval [95% CI] 1.45-3.52). When end points were analyzed separately, the RR for coronary heart disease was 2.25 (95% CI 1.37-3.69) and the RR for stroke was 2.29 (95% CI 0.85-6.15).
CONCLUSION: In this prospective population-based study, we found a statistically significant >2-fold increased risk of cardiovascular disease among participants with SLE. The risk was not as high as has been previously reported, which may have been due to the relatively high age at diagnosis of SLE in this cohort.