Patients with cutaneous lupus erythematosus (CLE) and subtype chronic discoid lupus erythematosus (DLE) are at increased risk for multiple cardiovascular events and diseases, according to a population-based retrospective cohort study published in eBioMedicine.
DLE and subacute cutaneous lupus erythematosus (SCLE) are the most frequent subtypes of CLE, disproportionately affecting women and Black patients. While patients with CLE may be at increased risk for cardiac and vascular complications, data on this topic are incomplete. Thus, researchers assessed cardiac and vascular outcomes among patients diagnosed with CLE, DLE, and SCLE.
Data were taken from medical records provided by the Global Collaborative Network of Tri-NetX. Patients aged 18 to 85 years with a diagnosis of CLE, DLE, and SCLE were included in the analysis, along with a control group. Propensity matching was performed to determine risk for cardiac and vascular diseases and outcomes.
A total of 30,315 patients with CLE, 27,427 with DLE, and 1613 with SCLE were included in the analysis. The control group was comprised of 4,343,385 individuals without lupus. Patients with SCLE were of more advanced age at diagnosis (mean age, 58.15±15.18 years) compared with other subtypes and the control group. The majority of patients in all lupus groups were women (CLE, 77.16%; DLE, 77.21%; SCLE, 77.32%). There were slightly more Black patients in the CLE (16.88%) and DLE (17.61%) groups, while patients with SCLE (73.09%) were more frequently White.
The risk for arterial embolism and thrombosis was higher among all lupus subtypes, including CLE (hazard ratio [HR],1.399; P <.0001), DLE (HR, 1.445; P <.0001), and SCLE (HR, 1.592; P =.0296). Patients with CLE and DLE more frequently experienced pulmonary embolism, CLE (HR, 1.195; P =.0111), DLE (HR, 1.158; P =.0421); cerebral infarction, CLE (HR, 1.428), DLE (HR, 1.423; both P <.0001); and acute myocardial infarction, CLE (HR, 1.177; P =.0038), DLE (HR, 1.11; P =.0691 [value not significant]).
Patients with CLE and DLE were at greater risk for peripheral arterial vascular disease, CLE (HR, 1.330), DLE (HR, 1.372; both P <.0001) and pericarditis, CLE (HR, 1.467), DLE (HR, 1.312; both P <.0001).
While analyses revealed patients with subtype SCLE were also at increased risk for the above cardiovascular diseases and events, these associations were not as strong compared with CLE and DLE.
Risk for all-cause mortality over 5 years was increased among all patients with lupus subtypes, with the highest risk among those diagnosed with SCLE (HR, 1.713; P =.0068) vs CLE (HR, 1.304; P <.0001), and DLE (HR, 1.247; P <.0001).
This study was limited by its retrospective design, potential for misdiagnosis and false coding in TriNetX, and lack of data on disease severity and progression.
The researchers concluded,” Our findings have important clinical implications for the management and primary prophylaxis in patients with CLE. Even though no novel CLE-specific treatment rationale can be derived from the presented data, the potential risk of subsequent cardiovascular disease should be considered in the care of CLE patients, which includes screening and optimal management of other additional cardiovascular risk factors.”
Olbrich H, Kridin K, Zirpel H, et al. Cutaneous lupus erythematosus is associated with an increased risk of cardiac and vascular diseases: a large-scale, propensity-matched global retrospective cohort study. EBioMedicine. Published online June 5, 2023. doi:10.1016/j.ebiom.2023.104639