The higher risk of cardiovascular morbidity and mortality that has been repeatedly observed among patients with systemic lupus erythematosus (SLE) may extend only to stroke and transient ischemic attack among patients with disease limited to the skin and not to ischemic heart disease, heart failure, or peripheral arterial disease, according to a study of the residents of Olmsted County, Minn.
Dr. Abha G. Singh of the Mayo Clinic, Rochester, Minn., and colleagues identified 155 patients with incident cutaneous lupus erythematosus (CLE) during 1965-2005 and followed them until 2013 (for a median duration of 14.6 years). A total of 41 patients developed 15 strokes or transient ischemic attacks, 32 cases of ischemic heart disease (including 11 MIs), 22 cases of heart failure, and 20 cases of peripheral arterial disease, making the cumulative 20-year incidence of any cardiovascular event 31.6%.
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A multivariate analysis involving age-, sex-, and calendar year–matched controls without CLE found significantly elevated risk for stroke or TIA (hazard ratio, 2.97; 95% confidence interval, 1.13-7.78) and borderline higher risk for peripheral arterial disease (HR, 2.06; 95% CI, 0.99-4.32), but risk of heart failure (HR, 1.27; 95% CI, 0.65-2.49) or ischemic heart disease, including coronary artery disease, MI, and angina, was not increased (HR, 0.94; 95% CI, 0.57-1.54). (All comparisons were adjusted for smoking.) CLE did not affect cardiovascular mortality, and its severity (generalized vs. localized disease) did not influence risk for any of the outcomes, the investigators said.
“While CLE shares genetic and pathophysiologic background with SLE, the inflammatory burden is less with no internal organ involvement. This may explain the absence of a significant increase in cardiovascular risk in patients with CLE,” the investigators wrote. “It is unclear why there was an apparent increase in risk of [cerebrovascular accidents] in patients with CLE (compared to subjects without CLE), without an increase in risk of [ischemic heart disease] or heart failure. This may be a true finding, and vascular inflammation associated with CLE may predispose patients to cerebrovascular accident.”
The study was published online in Arthritis Care & Research (Arthritis Care Res. 2016 Mar 25. doi: 10.1002/acr.22892).