The following article is a part of conference coverage from the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, being held in Atlanta, Georgia. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the 2019 ACR/ARP Annual Meeting.


ATLANTA — The initiation of glucocorticoid use may be associated with a significantly increased risk for cardiovascular disease (CVD) among patients with systemic lupus erythematosus (SLE), according to research results presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

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Study data also indicated that higher risk was associated with current use of glucocorticoids, higher current and cumulative glucocorticoid dose, and longer duration of glucocorticoid use.

In the current study, researchers evaluated the effect of glucocorticoid use and the risk for CVD in SLE.

Investigators analyzed data from inpatient and outpatient visits, demographic factors, cancer registry and vital statistics, and medication dispensed to patients with SLE between January 1997 and March 2015 in British Columbia, Canada. The incident cohort of patients who received healthcare in this time period had no glucocorticoid exposure before onset of SLE. Cardiovascular events (stroke or myocardial infarction) were identified by hospitalization and vital statistics data. Patient data were evaluated until 1 of the following occurred: a CVD outcome, death, end of follow-up, or the patient leaving British Columbia.

The effect of glucocorticoid initiation on CVD risk was estimated using the marginal structure Cox model, adjusting for covariates. Glucocorticoid exposure was defined in 4 more ways: current use, current dose, cumulative dose, and cumulative duration. Weighted versions of the cumulative dose and duration were used to allow for the effects of the previous 180 days of glucocorticoid exposure varying by recency. Researchers used Cox proportional hazard models to estimate the risk for CVD associated with each exposure measure.

At baseline, the data of 2653 patients with incident SLE and no history of glucocorticoid use were assessed (mean age, 47 years; 86% women). Of these patients, 1720 (65%) received glucocorticoids during follow-up, with an average of 15% of the follow-up time on a median dose of 5 mg/d for a median duration per glucocorticoid course of 29 days.

During the follow-up period, 108 cardiovascular disease events were identified (myocardial infarction, 69; stroke, 45). The hazard ratio (HR) after glucocorticoid initiation was 1.82 (95% CI, 1.18-2.81). Both current glucocorticoid use and current daily dose were associated with a significantly increased cardiovascular disease risk (HR, 1.76; 95% CI, 1.06-2.94 and HR, 1.14; 95% CI, 1.03-1.26, respectively). Concave function for both cumulative dose and cumulative duration of use were statistically significant (HR, 1.59; 95% CI, 1.23-2.05 and HR, 1.21; 95% CI, 1.04-1.41, respectively).

“The initiation of GC use is associated [with] an 82% increased risk for CVD during follow-up. Higher risk for CVD is also associated with current glucocorticoid use, higher current and cumulative glucocorticoid dose and longer duration of glucocorticoid use,” the researchers concluded.

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Reference

Li L, Xie H, Sayre E, Avina-Zubieta JA. Risk of cardiovascular disease associated with the use of glucocorticoids in patients with incident systemic lupus erytematosus: A population-based study. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 2781.