Patients with lupus at highest risk for ischemic heart disease 6 to 9 years post-diagnosis
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Key takeaways:
- Patients with lupus are at an increased risk for ischemic heart disease.
- Pollution also contributes to IHD manifestation.
Patients with systemic lupus erythematosus demonstrate a higher risk for ischemia heart disease, with the biggest danger manifesting 6 to 9 years after diagnosis, according to data published in BMC Rheumatology.
“[Ischemic heart disease (IHD)] is a serious disease that entails a high probability of sudden death,” Pei-Yun Chen, MD, of the department of public health at China Medical University, in Taiwan, and colleagues wrote. “Although some IHD-related risk factors cannot be modified, others can be mitigated if a high-risk patient is identified in time to devise a prevention strategy.
“It is therefore desirable to determine whether inflammation-related diseases are associated with IHD,” they added. “... SLE-related risk factors continue to be investigated. Even though health care quality has improved for SLE and IHD in the last century, SLE progression to IHD is still unavoidable. The major difference between today and the previous century is air pollution.”
To investigate the relationship between IHD, lupus and air pollution exposure, Chen and colleagues conducted a retrospective cohort study spanning 12 years of data from the National Health Insurance Research Database of Taiwan. Patients aged 20 years and older in 2006 with SLE were included in the study. The researchers additionally used data from patients without SLE to serve as the control group.
Patients’ exposure to air pollution was determined by matching their residences to the nearest Air Quality Index station. Chen and colleagues considered inflammation-related diseases, such as diabetes and hypertension, as possible confounders. They also assessed variables that impacted the development of SLE and IHD, such as age and sex of participants.
The analysis included 4,842 patients with SLE and 19,368 patients without SLE. At the end of 2018, the researchers reported that the risk for IHD was “significantly higher” in patients with SLE vs. patients without (HR = 2.42; P < .01). According to the researchers, the risk was at its highest between the sixth and ninth years from SLE diagnosis. Additional factors that correlated with the development of IHD included sex, age, carbon monoxide exposure, nitrogen dioxide exposure and exposure to PM10 and PM2.5.
“Subjects with SLE were at a higher risk of IHD, especially those in the 6th to 9th year after SLE diagnosis,” Chen and colleagues wrote. “Since the highest risk for developing IHD in SLE patients is during this period, it is recommended that advanced cardiac health examinations be included in the health insurance benefits for SLE patients in the fifth to ninth year after SLE diagnosis.”
Perspective
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The longer I care for patients with systemic lupus erythematosus, the more I realize it is one of the most unrelenting and complex diseases in rheumatology. Research surrounding lupus has improved our understanding of the inflammatory nature of the disease, aided in the development of new treatments, and has identified potential comorbidities for this unique population.
Chen and colleagues addressed a major comorbidity for patients with SLE — heart disease. The twist in this study was examining air pollution as a risk factor for developing heart disease in the lupus population of Taiwan.
I believe the conclusions drawn from this study have less to do with air quality and more to do with how we educate our patients. As we strive to take a holistic approach to caring for our patients, it is vitally important we spend time explaining the importance of such things as a healthy diet, weight control, exercise and smoking cessation in a way that meets our patients’ individual needs and life circumstances.
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