Cutaneous lupus erythematosus associated with cardiovascular disease

Key takeaways:

• Patients with cutaneous lupus were 1.72 times more likely to have cardiovascular disease than matched controls.
• The incidence rate of cardiovascular disease among these patients per 1,000 patient-years was 15.2.

Patients with cutaneous lupus erythematosus may be at an increased risk for atherosclerotic cardiovascular disease, even more than those with psoriasis, according to a study.

“In dermatology, there is an emerging trend of evaluating comorbid disease with various dermatologic diseases,” Henry W. Chen, MD, a dermatology resident at the University of Texas Southwestern Medical Center, told Healio. “This has been shown pretty well in psoriasis with an association of atherosclerotic disease (ASCVD). So, in this study, we sought to elucidate a potential association with ASCVD and cutaneous lupus erythematosus (CLE).”

The retrospective, matched, longitudinal, cohort study included 8,138 patients with strictly CLE and, for comparison, 24,675 patients with systemic lupus erythematosus (SLE), 192,577 with psoriasis and 81,380 controls.

Results showed that, compared with matched controls, patients with CLE were 1.72 (95% CI, 1.45-2.02) times more likely to have ASCVD, including myocardial infarctions, cerebrovascular accidents and coronary artery disease. Expectedly, the odds of ASCVD were lower among patients with CLE compared with SLE (OR = 2.41; 95% CI, 2.14-2.7), but interestingly they were higher compared with patients with psoriasis (OR = 1.03; 95% CI, 0.95-1.11).

“We didn’t see a lot of association with cardiovascular disease within the psoriasis cohort compared with controls that were matched against CLE patients,” Chen explained. “But one of the thoughts with that was that this study was designed to be matched to the CLE patients, so it’s possible some of the study design did not show a signal in psoriasis patients as our primary interest was CLE patients.”

After a median 3-year follow-up period, incidence rates of ASCVD per 1,000 person-years were highest in the SLE cohort (24.8; 95% CI, 23.3-26.4). This was followed by patients with CLE (15.2; 95% CI, 13.1-17.7) and those with psoriasis (14; 95% CI, 13.5-14.4).

According to a multivariable Cox proportional regression model, patients with SLE were 2.23 (95% CI, 2.05-2.43) times more likely to experience new onset ASCVD, patients with CLE were 1.32 (95% CI, 1.13-1.55) times more likely and those with psoriasis were 1.06 (95% CI, 0.99-1.13) times more likely compared with controls.

According to Chen, this study builds upon prior work and helps lay the groundwork for understanding that there is an association between CLE and ASCVD. He encourages dermatologists to make sure that patients with CLE are plugged in with a primary care physician who is screening them for cardiovascular disease, diabetes and other comorbidities.

“Dermatologists have the opportunity to intervene early as the skin is often viewed as a window to systemic disease,” Chen told Healio. “Thus, I believe this understanding is one way we can help our patients with CLE by ensuring they are receiving appropriate screenings and by advocating for institution of timely interventions.”