Cardiovascular disease risk awareness in systemic lupus erythematosus patients

Scalzi, Lisabeth V.; Ballou, Stanley P.; Park, Jean Y.; Redline, Susan; Kirchner, H. Lester

doi:10.1002/art.23419

Cited by 23 publications

(16 citation statements)

References 18 publications

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“…The prevalence of the different CVD risk factors in SLE patients ranges between 20–50% for hypertension, 3–9% for diabetes mellitus, 9–15% for dyslipidemia, 15–38% for smoking, and 16–22% for metabolic syndrome (compared to 5–6% in the general population) . Despite the increased prevalence of CVD risk factors in SLE patients, many lupus patients are not aware of their increased risk of CVD, and they do not receive routine screening and counseling for CVD risk factors . Our study confirms that SLE patients generally do not perceive “lupus” as a CVD risk factor, as only 22% of our patients who completed the baseline survey were aware of their lupus‐associated CVD risk.…”

Section: Discussionsupporting

confidence: 68%

Cardiovascular Disease Prevention Counseling Program for Systemic Lupus Erythematosus Patients

Yelnik

Richey

Haiduc

et al. 2017

Arthritis Care & Research

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Objective To determine if a cardiovascular disease prevention (CVD) counseling program for lupus patients decreases the prevalence of CVD risk factors. Methods The assessment phase of three-year CVD prevention counseling program included the evaluation of CVD risk factors, diet, exercise habits, and medications. The education phase included discussion of the above risk factors as well as CVD and thrombosis prevention strategies. Patients were prospectively followed every 3–6 months for risk assessment and continued education by a nurse practitioner and a medical doctor. Results Between March 2009 and December 2014, 121 patients were included. At baseline, abnormal blood pressure, blood glucose, cholesterol profile, and body mass index were found in 50 (41%), 7 (6%), 82 (68%), and 77 (64%) of patients, respectively. During the three-year follow-up, among those with abnormal baseline values: a) prevalence of abnormal blood pressure significantly decreased (OR: 0.94, 95% CI: 0.92–0.96, p<0.0001) with significant mean systolic blood pressure improvement (−6.12 ± 2.16 mmHg, p<0.05); b) prevalence of abnormal cholesterol profile significantly decreased (OR: 0.90; 95% CI: 0.92–0.96) with significant improvements in mean high-density lipoprotein (+5.4 ± 0.36 mg/dl, p<0.0001) and mean triglyceride levels (−12.6 ± 0.81 mg/dl, p<0.05); and c) no significant change in blood glucose and body mass index were observed. At baseline, 100 (83%) and 95 (79%) patients had poor diet and physical activity; during the follow-up, both significantly improved in the entire population. Conclusion Our data suggest that a CVD prevention counseling program decreases the prevalence of some CVD risk factors in lupus patients.

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Section: Discussionsupporting

confidence: 68%

Cardiovascular Disease Prevention Counseling Program for Systemic Lupus Erythematosus Patients

Yelnik

Richey

Haiduc

et al. 2017

Arthritis Care & Research

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“…We present our recommendations for potentially modifiable risk factors based on data from other high-risk populations (e.g., diabetics) since multiple barriers, such as recruitment and retention, have been identified when studying risk factor reduction in SLE [134]. In addition, patient and physician awareness of the problem is insufficient and results in underappreciation of the significance of the problem [135,136]. Furthermore, patients list medication concerns at the forefront of factors that limit their study participation [137].…”

Section: Treatment and Management Recommendationsmentioning

confidence: 99%

Management of cardiovascular complications in systemic lupus erythematosus

Skamra¹,

Ramsey‐Goldman

2010

International Journal of Clinical Rheumatology

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Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients with SLE have an excess risk compared with the general population; this is particularly pronounced in younger women with SLE who have an excess risk of over 50-fold compared with population controls. There is a higher prevalence of subclinical atherosclerosis in patients with SLE compared with controls, as demonstrated by a variety of imaging modalities discussed in this review. The causality of the excess risk of CVD and subclinical atherosclerosis is multifactorial in patients with SLE. While traditional risk factors play a role, after controlling for the traditional Framingham risk factors, the excess risk is still 7.5-fold greater than the general population. This review will also cover novel cardiovascular risk factors and some SLEspecific variables that contribute to CVD risk. This review discusses the risk factor modification and the evidence available for treatment of these risk factors in SLE. There have not yet been any published randomized, controlled trials in patients with SLE with respect to CVD risk factor modifications. Thus, the treatment and management recommendations are based largely on published guidelines for other populations at high risk for CVD. Keywordscardiac imaging; cardiovascular disease; cardiovascular risk factors; subclinical atherosclerosis; systemic lupus erythematosusIn the last few decades, the prognosis of patients with systemic lupus erythematosus (SLE) has improved immensely. In the 1950s, the 5-year survival rate for SLE was approximately 50% according to a study performed in Toronto, Canada. Subsequent studies have found 5-year survival rates of 90% in patients with SLE [1]. A bimodal mortality pattern was first described in 1976 by Urowitz et al. in the Toronto Lupus cohort. Septicemia in the setting of high-dose prednisone was identified as an early cause of death in patients with more active SLE. Later in the disease course, death was associated with inactive SLE, long duration of prednisone therapy and myocardial infarction (MI) due to atherosclerotic heart disease [2]. More recent data from a large international cohort revealed a 60% decrease in the standardized all-cause mortality rates (SMR) from 1970-1979 (SMR: 4.9) to 1990. However, the SMR trend for cardiovascular disease (including heart disease, arterial disease and stroke) did not decline from 1970 to 2001 [3]. A Swedish cohort followed from 1964 to 1994 demonstrated similar findings of improved overall survival for patients with SLE over the last two decades, but the risk of cardiovascular death remained (by 1985-1994 NIH Public Access Author ManuscriptInt J Clin Rheumtol. Author manuscript; available in PMC 2010 December 1. Published in final edited form as:Int J Clin Rheumtol. This review will discuss the increased risk of CVD observed in patients with SLE, the role of traditional cardiovascular risk factors, the role of novel risk factors (some of which are lu...

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“…Recent studies suggest ongoing deficiencies in awareness of, or other barriers to, risk factor assessment. Studies using data from cardiovascular health questionnaires and medical records have shown that 58% of patients reported never having received CVD counseling , while serum lipid profiles and body weight were recorded in only one‐third of patients, and physical activity and family CVD history were recorded in fewer than 10% of patients . Demas and colleagues reported that only 3% of patients with SLE treated at an academic center had annual assessment of 5 risk factors previously proposed as quality indicators for CVD (smoking, blood pressure, body mass index, diabetes, and serum lipids), while 26% had 4 risk factors assessed .…”

Section: Discussionmentioning

confidence: 99%

Brief Report: Trends in Hospitalizations Due to Acute Coronary Syndromes and Stroke in Patients With Systemic Lupus Erythematosus, 1996 to 2012

Tektonidou

Wang

Ward

2016

Arthritis & Rheumatology

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Objectives Cardiovascular disease (CVD) has been recognized as a major cause of morbidity in patients with systemic lupus erythematosus (SLE), but it is not clear if increased awareness of these risks has translated into improvements in CVD morbidity at the population level. To determine this, we examined national trends in rates of hospitalizations for CVD events in patients with SLE from 1996 to 2012. Methods We used the Nationwide Inpatient Sample to estimate rates of hospitalizations for acute myocardial infarction, unstable angina, and ischemic stroke from 1996 to 2012 in patients with SLE. We compared these trends to those in the general population. Results During the study years, there were an estimated 31,012 hospitalizations for acute myocardial infarction, 4,160 hospitalizations for unstable angina, and 26,144 hospitalizations for ischemic stroke among patients with SLE. Rates of hospitalizations for acute myocardial infarction and ischemic stroke increased over time in patients with SLE, while rates for unstable angina decreased. Rates for all three conditions decreased in the general population over these years, with hospitalization rates for unstable angina decreasing faster in the general population than among patients with SLE. Conclusion Increased awareness of the burden of CVD in patients with SLE has not yet translated into decreases in hospitalizations for acute myocardial infarction or stroke. This may be due to barriers in implementation of CVD risk factor modification, or SLE-specific risks that have not yet been identified or effectively targeted.

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Cardiovascular disease risk awareness in systemic lupus erythematosus patients

Cited by 23 publications

References 18 publications

Cardiovascular Disease Prevention Counseling Program for Systemic Lupus Erythematosus Patients

Cardiovascular Disease Prevention Counseling Program for Systemic Lupus Erythematosus Patients

Management of cardiovascular complications in systemic lupus erythematosus

Brief Report: Trends in Hospitalizations Due to Acute Coronary Syndromes and Stroke in Patients With Systemic Lupus Erythematosus, 1996 to 2012

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