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Use of hydroxychloroquine and risk of major adverse cardiovascular events in patients with lupus erythematosus: A Danish nationwide cohort study

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@article{67c5494d48da49d888c2345823ac9ce2,
title = "Use of hydroxychloroquine and risk of major adverse cardiovascular events in patients with lupus erythematosus: A Danish nationwide cohort study",
abstract = "BACKGROUND: Limited data suggest that hydroxychloroquine may affect risk of cardiovascular disease in patients with lupus erythematosus (LE).OBJECTIVE: To investigate whether hydroxychloroquine treatment is associated with major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or cardiovascular-associated death) in patients with cutaneous LE (CLE) or systemic LE (SLE).METHODS: Based on the Danish nationwide registers, an observational cohort study was conducted including patients with first-time diagnosis of CLE or SLE (between 1997 and 2017). Cox regression models calculating the hazard ratio (HR) analyzing the risk of MACE were performed comparing time on and off hydroxychloroquine (including never users). The models were adjusted for age, sex, socioeconomic status, concomitant treatment, and cardiovascular risk factors.RESULTS: Among 4587 patients with LE, 51% (n = 2343) were treated with hydroxychloroquine during the study period. An inverse association between use of hydroxychloroquine and MACE risk was observed among patients with SLE (adjusted HR, 0.65; 95% confidence interval, 0.46-0.90) and patients with CLE (adjusted HR, 0.71; 95% confidence interval, 0.42-1.19). Consistent results were found in sensitivity analyses including a case-time control design.LIMITATIONS: No information on disease activity/severity was available.CONCLUSION: Our findings indicate an opportunity to reduce the risk of cardiovascular events in patients with LE through use of hydroxychloroquine.",
keywords = "Adult, Brain Ischemia/chemically induced, Cardiovascular Diseases/mortality, Cohort Studies, Comorbidity, Confounding Factors, Epidemiologic, Denmark/epidemiology, Diabetes Mellitus/epidemiology, Female, Humans, Hydroxychloroquine/adverse effects, Hypercholesterolemia/epidemiology, Hypertension/epidemiology, Incidence, Income, Lupus Erythematosus, Cutaneous/drug therapy, Lupus Erythematosus, Systemic/drug therapy, Male, Middle Aged, Myocardial Infarction/chemically induced, Proportional Hazards Models, Registries, Risk, Smoking Cessation/statistics & numerical data, Smoking/epidemiology, Social Class, major adverse cardiovascular event, systemic lupus erythematosus, hydroxychloroquine, cutaneous lupus erythematosus, cardiovascular disease",
author = "Haugaard, {Jeanette Halskou} and Lene Dreyer and Ottosen, {Mathias Bo} and Gunnar Gislason and Kristian Kofoed and Alexander Egeberg",
note = "Copyright {\textcopyright} 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.",
year = "2021",
month = apr,
doi = "10.1016/j.jaad.2020.12.013",
language = "English",
volume = "84",
pages = "930--937",
journal = "American Academy of Dermatology. Journal",
issn = "0190-9622",
publisher = "Mosby, Inc",
number = "4",

}

RIS

TY - JOUR

T1 - Use of hydroxychloroquine and risk of major adverse cardiovascular events in patients with lupus erythematosus

T2 - A Danish nationwide cohort study

AU - Haugaard, Jeanette Halskou

AU - Dreyer, Lene

AU - Ottosen, Mathias Bo

AU - Gislason, Gunnar

AU - Kofoed, Kristian

AU - Egeberg, Alexander

N1 - Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2021/4

Y1 - 2021/4

N2 - BACKGROUND: Limited data suggest that hydroxychloroquine may affect risk of cardiovascular disease in patients with lupus erythematosus (LE).OBJECTIVE: To investigate whether hydroxychloroquine treatment is associated with major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or cardiovascular-associated death) in patients with cutaneous LE (CLE) or systemic LE (SLE).METHODS: Based on the Danish nationwide registers, an observational cohort study was conducted including patients with first-time diagnosis of CLE or SLE (between 1997 and 2017). Cox regression models calculating the hazard ratio (HR) analyzing the risk of MACE were performed comparing time on and off hydroxychloroquine (including never users). The models were adjusted for age, sex, socioeconomic status, concomitant treatment, and cardiovascular risk factors.RESULTS: Among 4587 patients with LE, 51% (n = 2343) were treated with hydroxychloroquine during the study period. An inverse association between use of hydroxychloroquine and MACE risk was observed among patients with SLE (adjusted HR, 0.65; 95% confidence interval, 0.46-0.90) and patients with CLE (adjusted HR, 0.71; 95% confidence interval, 0.42-1.19). Consistent results were found in sensitivity analyses including a case-time control design.LIMITATIONS: No information on disease activity/severity was available.CONCLUSION: Our findings indicate an opportunity to reduce the risk of cardiovascular events in patients with LE through use of hydroxychloroquine.

AB - BACKGROUND: Limited data suggest that hydroxychloroquine may affect risk of cardiovascular disease in patients with lupus erythematosus (LE).OBJECTIVE: To investigate whether hydroxychloroquine treatment is associated with major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or cardiovascular-associated death) in patients with cutaneous LE (CLE) or systemic LE (SLE).METHODS: Based on the Danish nationwide registers, an observational cohort study was conducted including patients with first-time diagnosis of CLE or SLE (between 1997 and 2017). Cox regression models calculating the hazard ratio (HR) analyzing the risk of MACE were performed comparing time on and off hydroxychloroquine (including never users). The models were adjusted for age, sex, socioeconomic status, concomitant treatment, and cardiovascular risk factors.RESULTS: Among 4587 patients with LE, 51% (n = 2343) were treated with hydroxychloroquine during the study period. An inverse association between use of hydroxychloroquine and MACE risk was observed among patients with SLE (adjusted HR, 0.65; 95% confidence interval, 0.46-0.90) and patients with CLE (adjusted HR, 0.71; 95% confidence interval, 0.42-1.19). Consistent results were found in sensitivity analyses including a case-time control design.LIMITATIONS: No information on disease activity/severity was available.CONCLUSION: Our findings indicate an opportunity to reduce the risk of cardiovascular events in patients with LE through use of hydroxychloroquine.

KW - Adult

KW - Brain Ischemia/chemically induced

KW - Cardiovascular Diseases/mortality

KW - Cohort Studies

KW - Comorbidity

KW - Confounding Factors, Epidemiologic

KW - Denmark/epidemiology

KW - Diabetes Mellitus/epidemiology

KW - Female

KW - Humans

KW - Hydroxychloroquine/adverse effects

KW - Hypercholesterolemia/epidemiology

KW - Hypertension/epidemiology

KW - Incidence

KW - Income

KW - Lupus Erythematosus, Cutaneous/drug therapy

KW - Lupus Erythematosus, Systemic/drug therapy

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/chemically induced

KW - Proportional Hazards Models

KW - Registries

KW - Risk

KW - Smoking Cessation/statistics & numerical data

KW - Smoking/epidemiology

KW - Social Class

KW - major adverse cardiovascular event

KW - systemic lupus erythematosus

KW - hydroxychloroquine

KW - cutaneous lupus erythematosus

KW - cardiovascular disease

UR - http://www.scopus.com/inward/record.url?scp=85099159241&partnerID=8YFLogxK

U2 - 10.1016/j.jaad.2020.12.013

DO - 10.1016/j.jaad.2020.12.013

M3 - Journal article

C2 - 33321159

VL - 84

SP - 930

EP - 937

JO - American Academy of Dermatology. Journal

JF - American Academy of Dermatology. Journal

SN - 0190-9622

IS - 4

ER -

ID: 67625557