Desmond YH Yap, MD, PhD
Credit: University of Hong Kong

An analysis of approximately 24 studies comparing outcomes between patients with systemic lupus erythematosus (SLE) has provided an overview of the additional cardiovascular risks associated with nephritis in these patients.

The presence of lupus nephritis (LN) is associated with an increased likelihood of cardiovascular risk factors such as dyslipidemia, diabetes, and hypertension, results of a meta-analysis of 22 studies including over 8,600 SLE patients. , it has been suggested that the likelihood is three times greater. Increased cardiovascular mortality.¹

“Our observations are clinically important. [cardiovascular disease] Risk factors are potentially amenable to treatment, and proper control of them can modulate the risk of infection. [cardiovascular] morbidity and mortality,” the researchers wrote.¹

According to the Lupus Foundation of America, an estimated 1.5 million people in the United States and more than 5 million people worldwide have some form of lupus, the most common of which is SLE. As a result of research efforts and improved management, the long-term prognosis associated with the diagnosis of SLE has increased in recent decades. With improvements in life expectancy, cardiovascular disease has emerged as the leading cause of death in SLE patients.^{2, 3}

With this in mind, a research team led by Desmond Y.H. Yap, MD, Clinical Associate Professor and Honorary Consultant at the Queen Mary Hospital, University of Hong Kong, investigated how the presence of LN affects cardiovascular The current study was initiated to better understand the Risk factors and complications in SLE patients. To that end, the researchers designed their research effort as a systematic review and meta-analysis of studies published on the topic from 1947 to 2022.¹

Researchers used PubMed, EMBASE, MEDLINE, and Scopus databases to search for observational studies, including cross-sectional, cohort, prospective, and retrospective studies, to determine the prevalence of cardiovascular disease in adult SLE patients. and reported risk factors for cardiovascular disease. No nephritis. Of note, the researchers performed two meta-analyses as part of the study, including a proportional meta-analysis and a meta-analysis of two-group studies.¹

The researchers’ initial search identified a total of 26,361 studies. After excluding duplicates and performing further screening, 186 articles underwent full-text review. A total of 58 studies were identified for inclusion, 22 of which were included in his final meta-analysis of two-arm studies.¹

These studies included 8675 patients with SLE, including 2295 patients with LN and 6380 patients without LN. These studies had a preponderance of women (86.7–100%) and varied follow-up periods (2–11 years). The researchers noted that all of these studies were conducted between 1990 and 2020.¹

The main findings of this study were differences in the incidence of myocardial infarction (MI), cerebrovascular events, hypertension, hyperlipidemia, diabetes, and plaque between SLE patients with and without nephritis. there were. Secondary outcomes of interest included differences in systolic and diastolic blood pressure, total cholesterol, LDL-C, HDL-C, and triglycerides.¹

Analysis suggests that SLE patients with nephritis are significantly more likely to have hypertension (odds ratio) [OR]4.93; 95% CI, 3.17-7.65; P <.00001, I2=56%), hyperlipidemia (OR, 11.0; 95% CI, 4.20-28.95; P <.00001, I2=0%) and diabetes (OR, 1.88; 95% CI, 1.09-3.25; P=.02, I2=32%) compared to those without nephritis. Further analysis noted a trend towards increasing prevalence of MI (OR, 1.35; 95% CI, 0.53-3.45; P=.52, I2=78%) and cerebrovascular accident (OR, 1.64; 95% CI, 0.79-3.39; P=.27, I2=23%), proportion of nephritis patients compared to general SLE patients. Additionally, mortality analysis suggested that patients with SLE and nephritis (11.7 per 1000 patient-years) had higher cardiovascular mortality than SLE patients without nephritis (3.6 per 1000 patient-years). .¹

The researchers highlighted multiple limitations within the study. These include the relatively small number of studies including cardiovascular data with and without LN, the use of often incomplete outcome definitions, and the lack of data on other major cardiovascular adverse events such as heart failure. was included. The researchers also called attention to the inherent limitations of studying hard cardiovascular events and mortality, including susceptibility to survivorship bias.¹

“Improving early survival rates means [cardiovascular] Morbidity and mortality are an increasing concern in the long-term management of SLE and LN patients. The results of our meta-analysis showed that the presence of LNs in SLE patients was associated with increased risk of various conventional diseases. [cardiovascular] Contains risk factors [hypertension]dyslipidemia, and [diabetes mellitus],Also, [cardiovascular] The mortality rate is also high,” investigators wrote.¹

References:

1. _{^{Wong CY, Ma BMY, Chan D, Chung W, Chan TM, Yap DYH. Cardiovascular risk factors and complications in patients with systemic lupus erythematosus with and without nephritis: a systematic review and meta-analysis. lupus science medicine. 2024;11(1):e001152. Published March 21, 2024. doi:10.1136/lupus-2024-001152}}
2. _{^{Yen EY, Shaheen M, Wu JMP et al. 46-year trends in systemic lupus erythematosus mortality in the United States from 1968 to 2013: a national population-based study. Ann Intern Med. 2017;167(11):777-785. doi:10.7326/M17-0102}}