Severe ischemic strokes are common in systemic lupus erythematosus patients, and a high level of disease activity predicts their occurrence, reported Dr. Jamal Mikdashi and his associates.
“The pathogenesis of ischemic stroke in SLE involves more than the traditional Framingham risk factors,” but the features that predict stroke are not well understood in this patient population, the researchers wrote (Stroke 2007;38:281–85).
They studied predictive factors using data from the University of Maryland lupus cohort, in which 238 SLE patients were enrolled from 1992 to 2004 and were followed for a mean of 8 years. Of these subjects, 90% were women and 66% were black.
Ischemic strokes occurred in 44 patients (18%), and 34 of these (77%) were severe strokes, Dr. Mikdashi, of the University of Maryland, Baltimore, and his associates reported.
The most prevalent subtype was large-artery/atherothrombotic strokes (45%), followed by small-vessel/lacunar infarcts (39%). Seven patients (16%) had recurrent strokes during follow-up.
Baseline SLE activity, the presence of cutaneous vasculitis, and higher prednisone doses were significantly more frequent on univariate analysis in subjects who had a stroke than in those who did not have a stroke. On multivariate analysis, only high SLE activity predicted stroke.
When subjects were divided according to the severity of SLE activity at baseline, those with higher SLE activity scores were at twice the risk for ischemic stroke and at nearly three times the risk for severe ischemic stroke, compared with subjects with low SLE activity scores.
These findings suggest that besides conventional risk factors, “SLE patients may possess other characteristics that render them at greater risk for ischemic strokes,” the investigators wrote.
Not surprisingly, hypercholesterolemia and hypertension also were found to be strong independent predictors of ischemic stroke. A substudy of statin therapy in this cohort indicated that it may reduce stroke risk.
“Further studies will determine whether treating hyperlipidemia and other traditional risk factors in SLE patients may substantially reduce or prevent the development of severe stroke and whether such measures will have impact on mortality, disability, and quality of life in SLE,” Dr. Mikdashi and his associates noted.