Systemic lupus erythematosus; stroke and myocardial infarction risk: a systematic review and meta-analysis

Yazdany, Jinoos; Pooley, Nick; Langham, Julia; Nicholson, Lindsay; Langham, Sue; Embleton, Nina; Wang, Xia; Desta, Barnabas; Barut, Volkan; Hammond, Edward R.

doi:10.1136/rmdopen-2020-001247

Cited by 49 publications

(43 citation statements)

References 56 publications

(66 reference statements)

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“…Cardiovascular disease (CVD) is a main cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) [ 1 , 2 ]. The 2020 meta-analysis by Yazdany et al [3] showed SLE to be associated with an increased risk of myocardial infarction (pooled relative risk, 2.99 [95% CI 2.34-3.82]). However, the prevalence and factors associated with congestive heart failure (CHF) in SLE patients have not been studied in sufficient depth [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure

Rúa-Figueroa

Pérez-Veiga

et al. 2022

Seminars in Arthritis and Rheumatism

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Background/objectives Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. Methods Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. Results The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p<0.0001), cardiac arrhythmia (7.38 [4.00-13.42], p<0.0001), pulmonary hypertension (3.71 [1.84-7.25], p<0.0002), valvulopathy (6.33 [3.41-11.62], p<0.0001), non-cardiovascular damage (1.29 [1.16-1.44], p<0.000) and calcium/vitamin D treatment (5.29 [2.07-16.86], p=0.0015). Female sex (0.46 [0.25-0.88], p=0.0147) and antimalarials (0.28 [0.17-0.45], p<0.000) proved to be protective factors. Conclusions Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect.

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Section: Introductionmentioning

confidence: 99%

Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure

Rúa-Figueroa

Pérez-Veiga

et al. 2022

Seminars in Arthritis and Rheumatism

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“…Fish oil, a rich source of omega-3 polyunsaturated fatty acids, has been shown to offer protective effects on cardiovascular mortality and morbidity in the general population [ 39 ]. As SLE is associated with an increased risk of stroke and myocardial infarction [ 40 ], patients may consume fish oil to reduce the risk of these serious cardiovascular events. Moreover, a recent meta-analysis of five randomized controlled trials suggested that omega-3 fatty acids could reduce SLE disease activity [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the use of complementary therapies in Taiwanese patients with systemic lupus erythematosus: a cross-sectional study

Chang

et al. 2021

BMC Complement Med Ther

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Background This study aimed to investigate the prevalence of and the factors associated with the regular use of complementary therapies for Taiwanese patients with systemic lupus erythematosus (SLE). Methods In this cross-sectional study, 351 patients with SLE were consecutively recruited from a regional hospital in southern Taiwan from April to August 2019. Demographic and clinical information, including the use of different types of complementary therapies, was ascertained using a self-constructed questionnaire. Disease-specific quality of life was measured using the Lupus Quality of Life (LupusQoL) questionnaire. SLE disease activity was assessed using the rheumatologist-scored Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K). Factors associated with the regular use of complementary therapies were evaluated using multiple logistic regression analyses. Results Of the 351 patients with SLE, 90.3% were female, and 60.1% were ≥ 40 years of age. The prevalence of the regular use of any type of complementary therapy was 85.5%. The five most popular types of complementary therapy used were (1) fitness walking or strolling, (2) Buddhist prayer or attending temple, (3) vitamin consumption, (4) calcium supplementation, and (5) fish oil supplementation. Multiple logistic regression analyses revealed that the significant and independent factors associated with the regular use of complementary therapies in patients with SLE were age ≥ 40 years (adjusted odds ratio [aOR] 2.76, p = 0.013), nonoverweight or nonobesity (aOR 0.29, p = 0.004), engagement in vigorous exercise in the past year (aOR 4.62, p = 0.002), a lower SLEDAI-2 K score (aOR 0.90, p = 0.029), and a lower score in the physical health domain of the LupusQoL (aOR 0.57, p = 0.001). Conclusions A high prevalence of complementary therapy use in Taiwanese patients with SLE was observed. Rheumatologists should routinely ask patients about their use of supplements to minimize the risk of interaction with medical therapy.

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“…There is a doubled risk of cerebrovascular disease and a tripled risk of MI 24,27 . This results in a 2-3-fold increase in mortality 27 .…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Cardiovascular risk management in patients with immune-mediated inflammatory diseases

Garc�a-Gonz�lez¹,

Molina-Esteban²,

Galindo-Izquierdo³

2021

JIMIDS

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Cardiovascular morbidity and mortality are increased in immune-mediated inflammatory diseases (IMIDs). Among other factors, chronic inflammation appears to be a cornerstone in the development of cardiovascular disease. The usual risk stratification tools tend to underestimate risk in patients with inflammatory diseases. Treatments used for IMIDs have an impact on how vascular disease presents. Through a narrative review of the literature, we summarize strategies for the detection of subclinical cardiovascular disease (atherosclerosis) and individual risk stratification. We also review the presentation of cardiovascular disease in each of the IMIDs. Finally, we present strategies for the management of cardiovascular risk in these patients.

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Systemic lupus erythematosus; stroke and myocardial infarction risk: a systematic review and meta-analysis

Cited by 49 publications

References 56 publications

Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure

Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure

Factors associated with the use of complementary therapies in Taiwanese patients with systemic lupus erythematosus: a cross-sectional study

Cardiovascular risk management in patients with immune-mediated inflammatory diseases

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