Study Identifies Risks of Nonfatal Cardiovascular Disease Events in Patients with Lupus
Patients with systemic lupus erythematosus (SLE) have a 27% higher risk of having a nonfatal cardiovascular disease (CVD) event compared to age- and sex-matched diabetes mellitus (DM) patients and more than twice the risk of the Medicaid general population, according to a new study led by a researcher at Hospital for Special Surgery (HSS) in New York City. The highest relative risk occurred between the ages of 18 and 39. These high risks merit aggressive evaluation for modifiable factors and research to identify prevention strategies. The study was made available online first in May 2020 ahead of publication today in Arthritis Care & Research.
“CVD risk has long been known to be elevated in SLE, especially among young patients, and remains the leading cause of death,” said lead study author Medha Barbhaiya, MD, MPH, an assistant attending rheumatologist from the Division of Rheumatology, Department of Medicine, Barbara Volcker Center for Women and Rheumatic Diseases at HSS and Weill Cornell Medical College. “However, unlike in DM, another chronic disease associated with premature atherosclerosis, where aggressive protocols are in place to reduce CVD risk, no such guidelines for primary or secondary prevention of CVD exist for patients with SLE. We aimed to quantify the risk of CVD in patients with SLE compared to those with DM and the general population.”
The researchers compared CVD risks of patients with lupus, patients with DM and general population U.S. Medicaid patients. In this cohort study, the researchers identified age- and sex-matched (1:2:4) adults with SLE, DM or in the general population from Medicaid Analytic eXtract between 2007 and 2010. They collected baseline sociodemographic factors, comorbidities and medications. Cox regression models calculated hazard ratios of hospitalized nonfatal CVD events (combined myocardial infarction [MI] and stroke) and MI and stroke separately accounting for competing risk of death and adjusting for covariates. They compared risks in age-stratified models.
“Our results show that Medicaid patients with SLE had a higher nonfatal stroke risk and similarly high risk of MI as patients with DM. MI and stroke risks were over twice the risk in SLE patients aged 18 to 39 years compared to patients with DM in the same age group,” explained Dr. Barbhaiya.
In all, the researchers identified 40,212 patients with SLE, 80,424 patients with DM and 160,848 non-SLE non-diabetes patients, of whom 92.5% were female, with a mean age of 40.3 (+/-12.1) years. Nonfatal CVD incidence rate per 1,000 person years was 27% higher in patients with SLE compared to patients with DM driven by excess risk in the 18 to 39 category (patients had 2.22 times the risk). Patients with SLE had 2.67 times higher risk of CVD compared to the general population.
“Despite a lower prevalence of traditional CVD risk factors, SLE patients had higher nonfatal stroke but similar MI risks as DM patients. MI and stroke risks were over twice the risk in SLE patients aged 18 to 39 years compared to their DM counterparts,” said Dr. Barbhaiya. “Our results suggest that early and aggressive CVD screening and better means of personalized CVD risk stratification and modification are needed for SLE patients. Additionally, future studies identifying the underlying mechanism of the observed excess CVD risk in SLE patients, particularly in younger patients between ages 18 to 39, are warranted.”
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.