Previous research suggests that patients with systemic lupus erythematosus (SLE) have a high risk of experiencing accelerated atherosclerosis events (AVE) in their early 40s and 50s, with AVE becoming a significant source of morbidity and mortality for the population. “This bimodal mortality pattern revealed that when mortality in patients with SLE occurred within the first 5 years of their disease, it was due to SLE or infection,” explains M.B. Urowitz, MD, FRCP(C). “Afterward, the cause of mortality was frequently an AVE, such as myocardial infarction or stroke due to atherosclerosis.”
For a study published in The Journal of Rheumatology, Dr. Urowitz and colleagues sought to determine the effects of early recognition and treatment of atherosclerosis and SLE to prevent AVE in recent decades. To better understand the risk of AVE for patients with SLE, the study team used their database containing patient demographics, clinical characteristics, routine bloodwork results, serologic findings, and therapies. Patients were grouped by those treated in 1975-1987 and followed to 1992 (cohort 1), and those treated in 1999- 2011 and followed to 2016 (cohort 2).
The analyzed data indicated a 60% reduction in risk for AVE in cohort 2 when compared with cohort 1; 11.0% of patients in cohort 1 had an AVE, compared with 3.8% of those in cohort 2 E. The incidence rate per 100 person years were 1.8 in cohort 1 and 0.44 in cohort 2. SLE risk factors, and classic atherosclerotic risk factors, were both better controlled in cohort 2 than in cohort 1.
“We must investigate for AVE risk factors early in the course of lupus and treat these risk factors, as well as strive for earlier and more complete resolution of active SLE, as the inflammation induced by lupus is a major contributor to the development of atherosclerosis,” explains Dr. Urowitz, noting, though, that “more effective therapies for lupus itself are needed to control the inflammatory response of this disease earlier and more completely.” In the meantime, he urges physicians to understand the role of AVE in SLE, implementing AVE treatment into therapy plans for patients with SLE as appropriate.
Atherosclerotic Vascular Events in Systemic Lupus Erythematosus: An Evolving Story