Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus

Adelina Yafasova; Emil L Fosbøl; Morten Schou; Bo Baslund; Mikkel Faurschou; Kieran F Docherty; Pardeep S Jhund; John J V McMurray; Guoli Sun; Søren L Kristensen; Christian Torp-Pedersen; Lars Køber; Jawad H Butt

doi:10.1016/j.jacc.2021.02.029

Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus

Adelina Yafasova, Emil L Fosbøl, Morten Schou, Bo Baslund, Mikkel Faurschou, Kieran F Docherty, Pardeep S Jhund, John J V McMurray, Guoli Sun, Søren L Kristensen, Christian Torp-Pedersen, Lars Køber, Jawad H Butt

29 Citations (Scopus)

Abstract

BACKGROUND: Data on long-term cardiovascular outcomes in systemic lupus erythematosus (SLE) are sparse.

OBJECTIVES: This study sought to examine the long-term risk and prognosis associated with cardiovascular outcomes, including heart failure (HF), in patients with SLE.

METHODS: Using Danish administrative registries, risks of outcomes were compared between SLE patients (diagnosed 1996 to 2018, no history of cardiovascular disease) and age-, sex-, and comorbidity-matched control subjects from the background population (matched 1:4). Furthermore, mortality following HF diagnosis was compared between SLE patients developing HF and age- and sex-matched non-SLE control subjects with HF (matched 1:4).

RESULTS: A total of 3,411 SLE patients (median age: 44.6 years [25th to 75th percentile: 31.9 to 57.0 years]; 14.1% men) were matched with 13,644 control subjects. The median follow-up was 8.5 years (25th to 75th percentile: 4.0 to 14.4 years). Absolute 10-year risks of outcomes were: HF, 3.71% (95% confidence interval [CI]: 3.02% to 4.51%) for SLE patients, 1.94% (95% CI: 1.68% to 2.24%) for control subjects; atrial fibrillation, 4.35% (95% CI: 3.61% to 5.18%) for SLE patients, 2.82% (95% CI: 2.50% to 3.16%) for control subjects; ischemic stroke, 3.75% (95% CI: 3.06% to 4.54%) for SLE patients, 1.92% (95% CI: 1.66% to 2.20%) for control subjects; myocardial infarction, 2.17% (95% CI: 1.66% to 2.80%) for SLE patients, 1.49% (95% CI: 1.26% to 1.75%) for control subjects; venous thromboembolism, 6.03% (95% CI: 5.17% to 6.98%) for SLE patients, 1.68% (95% CI: 1.44% to 1.95%) for control subjects; and the composite of implantable cardioverter-defibrillator implantation/ventricular arrhythmias/cardiac arrest, 0.89% (95% CI: 0.58% to 1.31%) for SLE patients, 0.30% (95% CI: 0.20% to 0.43%) for control subjects. SLE with subsequent HF was associated with higher mortality compared with HF without SLE (adjusted hazard ratio: 1.50; 95% CI: 1.08 to 2.08).

CONCLUSIONS: SLE patients had a higher associated risk of HF and other cardiovascular outcomes compared with matched control subjects. Among patients developing HF, a history of SLE was associated with higher mortality.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	77
Issue number	14
Pages (from-to)	1717-1727
Number of pages	11
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2021.02.029
Publication status	Published - 13 Apr 2021

Keywords

cardiovascular outcomes
heart failure
systemic lupus erythematosus

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10.1016/j.jacc.2021.02.029

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Yafasova, A., Fosbøl, E. L., Schou, M., Baslund, B., Faurschou, M., Docherty, K. F., Jhund, P. S., McMurray, J. J. V., Sun, G., Kristensen, S. L., Torp-Pedersen, C., Køber, L., & Butt, J. H. (2021). Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus. Journal of the American College of Cardiology, 77(14), 1717-1727. https://doi.org/10.1016/j.jacc.2021.02.029

@article{d5efb39c3adc45c8b3869be8b144f407,

title = "Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus",

abstract = "BACKGROUND: Data on long-term cardiovascular outcomes in systemic lupus erythematosus (SLE) are sparse.OBJECTIVES: This study sought to examine the long-term risk and prognosis associated with cardiovascular outcomes, including heart failure (HF), in patients with SLE.METHODS: Using Danish administrative registries, risks of outcomes were compared between SLE patients (diagnosed 1996 to 2018, no history of cardiovascular disease) and age-, sex-, and comorbidity-matched control subjects from the background population (matched 1:4). Furthermore, mortality following HF diagnosis was compared between SLE patients developing HF and age- and sex-matched non-SLE control subjects with HF (matched 1:4).RESULTS: A total of 3,411 SLE patients (median age: 44.6 years [25th to 75th percentile: 31.9 to 57.0 years]; 14.1% men) were matched with 13,644 control subjects. The median follow-up was 8.5 years (25th to 75th percentile: 4.0 to 14.4 years). Absolute 10-year risks of outcomes were: HF, 3.71% (95% confidence interval [CI]: 3.02% to 4.51%) for SLE patients, 1.94% (95% CI: 1.68% to 2.24%) for control subjects; atrial fibrillation, 4.35% (95% CI: 3.61% to 5.18%) for SLE patients, 2.82% (95% CI: 2.50% to 3.16%) for control subjects; ischemic stroke, 3.75% (95% CI: 3.06% to 4.54%) for SLE patients, 1.92% (95% CI: 1.66% to 2.20%) for control subjects; myocardial infarction, 2.17% (95% CI: 1.66% to 2.80%) for SLE patients, 1.49% (95% CI: 1.26% to 1.75%) for control subjects; venous thromboembolism, 6.03% (95% CI: 5.17% to 6.98%) for SLE patients, 1.68% (95% CI: 1.44% to 1.95%) for control subjects; and the composite of implantable cardioverter-defibrillator implantation/ventricular arrhythmias/cardiac arrest, 0.89% (95% CI: 0.58% to 1.31%) for SLE patients, 0.30% (95% CI: 0.20% to 0.43%) for control subjects. SLE with subsequent HF was associated with higher mortality compared with HF without SLE (adjusted hazard ratio: 1.50; 95% CI: 1.08 to 2.08).CONCLUSIONS: SLE patients had a higher associated risk of HF and other cardiovascular outcomes compared with matched control subjects. Among patients developing HF, a history of SLE was associated with higher mortality.",

keywords = "cardiovascular outcomes, heart failure, systemic lupus erythematosus",

author = "Adelina Yafasova and Fosb{\o}l, {Emil L} and Morten Schou and Bo Baslund and Mikkel Faurschou and Docherty, {Kieran F} and Jhund, {Pardeep S} and McMurray, {John J V} and Guoli Sun and Kristensen, {S{\o}ren L} and Christian Torp-Pedersen and Lars K{\o}ber and Butt, {Jawad H}",

year = "2021",

month = apr,

day = "13",

doi = "10.1016/j.jacc.2021.02.029",

language = "English",

volume = "77",

pages = "1717--1727",

journal = "American College of Cardiology. Journal",

issn = "0735-1097",

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number = "14",

}

TY - JOUR

T1 - Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus

AU - Yafasova, Adelina

AU - Fosbøl, Emil L

AU - Schou, Morten

AU - Baslund, Bo

AU - Faurschou, Mikkel

AU - Docherty, Kieran F

AU - Jhund, Pardeep S

AU - McMurray, John J V

AU - Sun, Guoli

AU - Kristensen, Søren L

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Butt, Jawad H

PY - 2021/4/13

Y1 - 2021/4/13

N2 - BACKGROUND: Data on long-term cardiovascular outcomes in systemic lupus erythematosus (SLE) are sparse.OBJECTIVES: This study sought to examine the long-term risk and prognosis associated with cardiovascular outcomes, including heart failure (HF), in patients with SLE.METHODS: Using Danish administrative registries, risks of outcomes were compared between SLE patients (diagnosed 1996 to 2018, no history of cardiovascular disease) and age-, sex-, and comorbidity-matched control subjects from the background population (matched 1:4). Furthermore, mortality following HF diagnosis was compared between SLE patients developing HF and age- and sex-matched non-SLE control subjects with HF (matched 1:4).RESULTS: A total of 3,411 SLE patients (median age: 44.6 years [25th to 75th percentile: 31.9 to 57.0 years]; 14.1% men) were matched with 13,644 control subjects. The median follow-up was 8.5 years (25th to 75th percentile: 4.0 to 14.4 years). Absolute 10-year risks of outcomes were: HF, 3.71% (95% confidence interval [CI]: 3.02% to 4.51%) for SLE patients, 1.94% (95% CI: 1.68% to 2.24%) for control subjects; atrial fibrillation, 4.35% (95% CI: 3.61% to 5.18%) for SLE patients, 2.82% (95% CI: 2.50% to 3.16%) for control subjects; ischemic stroke, 3.75% (95% CI: 3.06% to 4.54%) for SLE patients, 1.92% (95% CI: 1.66% to 2.20%) for control subjects; myocardial infarction, 2.17% (95% CI: 1.66% to 2.80%) for SLE patients, 1.49% (95% CI: 1.26% to 1.75%) for control subjects; venous thromboembolism, 6.03% (95% CI: 5.17% to 6.98%) for SLE patients, 1.68% (95% CI: 1.44% to 1.95%) for control subjects; and the composite of implantable cardioverter-defibrillator implantation/ventricular arrhythmias/cardiac arrest, 0.89% (95% CI: 0.58% to 1.31%) for SLE patients, 0.30% (95% CI: 0.20% to 0.43%) for control subjects. SLE with subsequent HF was associated with higher mortality compared with HF without SLE (adjusted hazard ratio: 1.50; 95% CI: 1.08 to 2.08).CONCLUSIONS: SLE patients had a higher associated risk of HF and other cardiovascular outcomes compared with matched control subjects. Among patients developing HF, a history of SLE was associated with higher mortality.

AB - BACKGROUND: Data on long-term cardiovascular outcomes in systemic lupus erythematosus (SLE) are sparse.OBJECTIVES: This study sought to examine the long-term risk and prognosis associated with cardiovascular outcomes, including heart failure (HF), in patients with SLE.METHODS: Using Danish administrative registries, risks of outcomes were compared between SLE patients (diagnosed 1996 to 2018, no history of cardiovascular disease) and age-, sex-, and comorbidity-matched control subjects from the background population (matched 1:4). Furthermore, mortality following HF diagnosis was compared between SLE patients developing HF and age- and sex-matched non-SLE control subjects with HF (matched 1:4).RESULTS: A total of 3,411 SLE patients (median age: 44.6 years [25th to 75th percentile: 31.9 to 57.0 years]; 14.1% men) were matched with 13,644 control subjects. The median follow-up was 8.5 years (25th to 75th percentile: 4.0 to 14.4 years). Absolute 10-year risks of outcomes were: HF, 3.71% (95% confidence interval [CI]: 3.02% to 4.51%) for SLE patients, 1.94% (95% CI: 1.68% to 2.24%) for control subjects; atrial fibrillation, 4.35% (95% CI: 3.61% to 5.18%) for SLE patients, 2.82% (95% CI: 2.50% to 3.16%) for control subjects; ischemic stroke, 3.75% (95% CI: 3.06% to 4.54%) for SLE patients, 1.92% (95% CI: 1.66% to 2.20%) for control subjects; myocardial infarction, 2.17% (95% CI: 1.66% to 2.80%) for SLE patients, 1.49% (95% CI: 1.26% to 1.75%) for control subjects; venous thromboembolism, 6.03% (95% CI: 5.17% to 6.98%) for SLE patients, 1.68% (95% CI: 1.44% to 1.95%) for control subjects; and the composite of implantable cardioverter-defibrillator implantation/ventricular arrhythmias/cardiac arrest, 0.89% (95% CI: 0.58% to 1.31%) for SLE patients, 0.30% (95% CI: 0.20% to 0.43%) for control subjects. SLE with subsequent HF was associated with higher mortality compared with HF without SLE (adjusted hazard ratio: 1.50; 95% CI: 1.08 to 2.08).CONCLUSIONS: SLE patients had a higher associated risk of HF and other cardiovascular outcomes compared with matched control subjects. Among patients developing HF, a history of SLE was associated with higher mortality.

KW - cardiovascular outcomes

KW - heart failure

KW - systemic lupus erythematosus

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U2 - 10.1016/j.jacc.2021.02.029

DO - 10.1016/j.jacc.2021.02.029

M3 - Journal article

C2 - 33832598

VL - 77

SP - 1717

EP - 1727

JO - American College of Cardiology. Journal

JF - American College of Cardiology. Journal

SN - 0735-1097

IS - 14

ER -

Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus

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