38% Higher Risk of Stroke in SLE

Nov 23, 2016

Patients with systemic lupus erythematosus have a 38 percent higher adjusted risk of stroke, shows a Harvard study presented at ACR 2016.

Patients with systemic lupus erythematosus (SLE) have a 38 percent higher adjusted risk of stroke, shows a Harvard study presented on Nov. 15 at the American College of Rheumatology annual meeting.

The study, led by Medha Barbhaiya, shows that despite a lower prevalence of many traditional cardiovascular disease risk factors as compared to age- and sex-matched diabetes mellitus patients, SLE patients had similar adjusted risks of both myocardial infarction and stroke.

“These findings may signal potential additional SLE-specific and thrombotic risk factors associated with elevated risk of stroke among SLE patients,” the authors wrote. These findings were also published in Arthritis & Rheumatology.

While elevated cardiovascular risk is known in systemic lupus erythematosus over the general population, it is not know how this risk is compared to other specific chronic diseases such as diabetes mellitus.

The authors used the Medicaid Analytic eXtract database collected between 2007 and 2010. Adults with diabetes mellitus or systemic lupus erythematosus were enrolled provided they had been in the database greater than 6 months before at least three visits with the desired diagnosis. One to two matching (lupus to diabetes) based on age, gender, and index date was performed and cardiovascular outcomes were assessed. Cox sub-distribution regression was utilized and hazard rations calculated for cardiovascular events.

The two groups were comprised of 64,178 patients with diabetes mellitus and 32,089 with systemic lupus erythematosus with 92.8% being women with an average age of 41.3 years.

The authors found that patients with diabetes had more baseline cardiovascular risk factors vs. those with systemic lupus erythematosus with the most common being: hypertension (38% to 33.7%), elevated lipids (22.5% to 10.6%, and obesity (11% to 4.5%). Risk of myocardial infraction was not statistically different between groups with a hazard ratio of 1.01 (95% CI 0.84-1.22). Finally, stroke risk was higher for those with systemic lupus erythematosus than those with diabetes mellitus with a hazard ratio of 1.38 (95% CI 1.20-1.60).

The authors point out the fact that patients with systemic lupus erythematosus had similar rates of myocardial infarction to spite the fact that they have fewer traditional risk factors for cardiovascular disease when compared to patients with diabetes mellitus. This underscores the increase in risk for cardiac events that patients with systemic lupus erythematosus have over the general population.

The similar rates of myocardial infarction and increased risk of stroke patients with systemic lupus erythematosus have compared to patients with diabetes suggests a link between the hypercoagulable states associated with SLE and thrombotic events in the cerebral and coronary arteries.

Key Points

Patients with systemic lupus erythematosus have similar risk for myocardial infarction, as do patients with diabetes mellitus, a known baseline risk factor for cardiovascular disease.

Patients with systemic lupus erythematosus have a higher risk for stroke than do patients with diabetes mellitus when adjusted for patient characteristics. 

These findings are significant especially in light of the fact that patients with diabetes often have several more risk factors for cardiovascular disease than those with systemic lupus erythematosus.

 

 

 

 

 

 

References:

Medha Barbhaiya. "Risk of Cardiovascular Disease Events Among Patients with Systemic Lupus Erythematosus Compared to Those with Diabetes Mellitus in a Nationwide Medicaid Cohort," Abstract 2989. 3 p.m., Nov. 15, 2016.  ACR/ARHP 2016 Annual Meeting.

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