Systemic lupus erythematosus (SLE) is associated with an increased risk for several cardiovascular diseases, and patients with lupus nephritis are especially at risk.
Xiaohong Lu, MD, of The First Affiliated Hospital of Xi’an Jiaotong University in Shaanxi, China, and colleagues conducted a systematic review and meta-analysis of 20 contemporary SLE studies from the United States and 10 other countries in North America, Europe, the Middle East, and Asia. Patients with SLE had a significant 2.3-, 2.3-, 2.7-, 2.6-, and 2.9-fold increased risk for atherosclerosis, stroke, myocardial infarction, peripheral vascular disease, and heart failure, respectively, compared with the general population, the investigators reported. Only the risk for coronary heart disease did not differ significantly among populations, according to results published in International Immunopharmacology.
Patients with lupus nephritis (LN) had a 1.8-fold higher risk for cardiovascular disease compared with patients with SLE alone based on data from 4 studies, Dr Lu’s team reported. Typically, LN develops in 16%-45% of SLE cases, the investigators noted..
With respect to cardiovascular risk factors, hypertension risk was significantly increased 2.3-fold in patients with SLE compared with the general population. Smoking, hyperlipidemia, and diabetes incidence did not differ appreciably.
Although the data are robust, the investigators acknowledged that CVD risks might differ by ethnic group, warranting further research.
According to the 2019 SLE guideline update from the European League Against Rheumatism (EULAR), clinicians should monitor patients with SLE for atherosclerotic risk factors and subclinical cardiovascular disease. EULAR suggests calculating patients’ 10-year risk of cardiovascular disease using the Systematic Coronary Risk Evaluation (SCORE), noting that the tool underestimates their actual risk. Clinicians can consider low-dose aspirin for primary prevention. Routine use of statins is not currently recommended for all patients but should be considered on the basis of lipid levels and traditional risk factors.
Lu X, Wang YH, Zhang J, et al. Patients with systemic lupus erythematosus face a high risk of cardiovascular disease: A systematic review and meta-analysis. Int Immunopharmacol. 2021 Feb 23;94:107466. doi:10.1016/j.intimp.2021.107466
Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78:736-745. doi:10.1136/annrheumdis-2019-215089