Women with lupus and a history of preeclampsia have almost fourfold higher odds of subsequent heart disease as measured by coronary artery calcium than do women with the disease who never had preeclampsia, according to findings from an exploratory study.
Women with systemic lupus erythematosus (SLE) are at an increased risk of pregnancy complications, including preeclampsia, preterm birth, and low birth weight, wrote Dr. Pin Lin of the division of rheumatology at Northwestern University, Chicago, and her colleagues (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000024]).
Using data from the longitudinal Study of Long-Term Vascular and Bone Outcomes in Lupus Erythematosus (SOLVABLE), the authors assessed the potential association between these adverse events and subsequent heart disease.
Of the 129 women included in the current study, there were 331 pregnancies, 66% of which occurred before the diagnosis of SLE.
Of the 56 women who reported an adverse event during pregnancy, 26 had at least one pregnancy complicated by preeclampsia, 36 had at least one pregnancy resulting in preterm birth, and 28 had at least one low-birth-weight infant. The women with or without complications had similar ages (44-45 years), SLE characteristics, and circulating markers of inflammation and endothelial activation. They also were similar with respect to many cardiovascular disease risk factors, except that hypertension occurred significantly more often among those with a history of complications (66% vs. 47%).
Results showed that women with a history of preeclampsia were more likely to have a coronary artery calcium (CAC) score greater than or equal to 10 (adjusted odds ratio, 3.7; 95% confidence interval, 1.2-11.9) than were women without a history of preeclampsia after adjustment for age and disease duration. However, the presence of plaque was not associated with this adverse pregnancy outcome, the authors reported.
Low birth weight and preterm birth were not associated with CAC or plaque.
Dr. Jinoos Yazdany
In an accompanying editorial, Dr. Julia F. Simard of Stanford (Calif.) University and Dr. Jinoos Yazdany of the University of California, San Francisco, said that despite a clear question and the clinical significance, the study design and data only hint at an answer (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000035]).
The work should be viewed as exploratory, they said, building a scientific foundation for more definitive studies that will answer questions like:
• Should pregnancy complications alert clinicians caring for women with SLE about subsequent CVD risks necessitating more aggressive risk factor modification?
• Should preeclampsia be viewed as a ‘failed cardiac stress test?’ and
• Does the presence of SLE and preeclampsia together substantially increase CVD risk greater than expected with either risk factor alone?
“As the body of evidence between CVD and pregnancy morbidity grows, this line of study may unlock key risk factors to aid in the identification and management of early CVD in women with SLE,” they concluded.
The study was supported by grants from the National Institutes of Health, the Mary Kirkland Center for Lupus Research, and Rheuminations Inc. No relevant financial disclosures were declared.