Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA.
Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA.
Semin Arthritis Rheum. 2019 Dec;49(3):389-395. doi: 10.1016/j.semarthrit.2019.06.005. Epub 2019 Jun 11.
Patients with systemic lupus erythematosus (SLE) have a similar risk of myocardial infarction as those with diabetes mellitus (DM). Whether the risk of heart failure (HF) in SLE is similar to the elevated risk in DM is unknown. We sought to estimate the rates and risks for HF hospitalization among US Medicaid patients with SLE and to compare them to those for DM and the general Medicaid population.
Using U.S. Medicaid data from 2007-2010, we identified patients with SLE or DM, and a matched cohort from the general Medicaid population and calculated incidence rates (IR), incidence rate ratios (IRR) and adjusted hazard ratios (HR) of a first HF hospitalization.
We identified 37,902 SLE (93% female, mean age 40.1 ± 12.1), 76,657 DM (93% female, mean age 40.0 ± 12.1), and 158,695 general Medicaid patients (93% female, mean age 40.2 ± 12.1). The IR per 1000-person years was 6.9 (95% CI 6.3-7.5) for SLE, 6.6 (95% CI 6.2-7.0) for DM, and 1.6 (95% CI 1.5-1.8) for general Medicaid patients. The highest IRR compared to general Medicaid was seen among SLE patients in age group 18-39 (14.7, 95% CI 13.9-15.5). Multivariable-adjusted HRs for HF compared to general Medicaid population were similar for SLE (2.7, 95% CI 2.3-3.1) and DM (3.0, 95% CI 2.6-3.4).
The incidence of HF among SLE patients was 2.7-fold higher than general Medicaid patients, and similar to DM. Further investigation into the biologic mechanism of HF among SLE compared to non-SLE and DM patients may shed light on the findings of this study.
系统性红斑狼疮（SLE）患者发生心肌梗死的风险与糖尿病（DM）患者相似。SLE 患者发生心力衰竭（HF）的风险是否与 DM 患者升高的风险相似尚不清楚。我们旨在评估美国医疗补助计划（Medicaid）患者中 SLE 患者 HF 住院的发生率，并将其与 DM 患者和一般 Medicaid 人群进行比较。
利用 2007-2010 年美国 Medicaid 数据，我们识别出 SLE 或 DM 患者，以及一般 Medicaid 人群中的匹配队列，并计算首次 HF 住院的发生率（IR）、发病率比值（IRR）和调整后的危险比（HR）。
我们确定了 37902 例 SLE（93%为女性，平均年龄 40.1±12.1）、76657 例 DM（93%为女性，平均年龄 40.0±12.1）和 158695 例一般 Medicaid 患者（93%为女性，平均年龄 40.2±12.1）。每 1000 人年的发病率为 6.9（95%可信区间 6.3-7.5）的 SLE、6.6（95%可信区间 6.2-7.0）的 DM 和 1.6（95%可信区间 1.5-1.8）的一般 Medicaid 患者。与一般 Medicaid 患者相比，年龄在 18-39 岁的 SLE 患者的发病率比值最高（14.7，95%可信区间 13.9-15.5）。与一般 Medicaid 人群相比，HF 的多变量调整 HR 在 SLE（2.7，95%可信区间 2.3-3.1）和 DM（3.0，95%可信区间 2.6-3.4）中相似。
SLE 患者 HF 的发生率是一般 Medicaid 患者的 2.7 倍，与 DM 患者相似。对 SLE 患者与非 SLE 和 DM 患者 HF 发生的生物学机制进行进一步研究，可能会阐明本研究的结果。
