系统性红斑狼疮的长期心血管结局。
Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus.
机构信息
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
J Am Coll Cardiol. 2021 Apr 13;77(14):1717-1727. doi: 10.1016/j.jacc.2021.02.029.
BACKGROUND
Data on long-term cardiovascular outcomes in systemic lupus erythematosus (SLE) are sparse.
OBJECTIVES
This study sought to examine the long-term risk and prognosis associated with cardiovascular outcomes, including heart failure (HF), in patients with SLE.
METHODS
Using Danish administrative registries, risks of outcomes were compared between SLE patients (diagnosed 1996 to 2018, no history of cardiovascular disease) and age-, sex-, and comorbidity-matched control subjects from the background population (matched 1:4). Furthermore, mortality following HF diagnosis was compared between SLE patients developing HF and age- and sex-matched non-SLE control subjects with HF (matched 1:4).
RESULTS
A total of 3,411 SLE patients (median age: 44.6 years [25th to 75th percentile: 31.9 to 57.0 years]; 14.1% men) were matched with 13,644 control subjects. The median follow-up was 8.5 years (25th to 75th percentile: 4.0 to 14.4 years). Absolute 10-year risks of outcomes were: HF, 3.71% (95% confidence interval [CI]: 3.02% to 4.51%) for SLE patients, 1.94% (95% CI: 1.68% to 2.24%) for control subjects; atrial fibrillation, 4.35% (95% CI: 3.61% to 5.18%) for SLE patients, 2.82% (95% CI: 2.50% to 3.16%) for control subjects; ischemic stroke, 3.75% (95% CI: 3.06% to 4.54%) for SLE patients, 1.92% (95% CI: 1.66% to 2.20%) for control subjects; myocardial infarction, 2.17% (95% CI: 1.66% to 2.80%) for SLE patients, 1.49% (95% CI: 1.26% to 1.75%) for control subjects; venous thromboembolism, 6.03% (95% CI: 5.17% to 6.98%) for SLE patients, 1.68% (95% CI: 1.44% to 1.95%) for control subjects; and the composite of implantable cardioverter-defibrillator implantation/ventricular arrhythmias/cardiac arrest, 0.89% (95% CI: 0.58% to 1.31%) for SLE patients, 0.30% (95% CI: 0.20% to 0.43%) for control subjects. SLE with subsequent HF was associated with higher mortality compared with HF without SLE (adjusted hazard ratio: 1.50; 95% CI: 1.08 to 2.08).
CONCLUSIONS
SLE patients had a higher associated risk of HF and other cardiovascular outcomes compared with matched control subjects. Among patients developing HF, a history of SLE was associated with higher mortality.
背景
系统性红斑狼疮（SLE）患者的长期心血管结局数据较为匮乏。
目的
本研究旨在评估 SLE 患者发生心力衰竭（HF）及其他心血管结局的长期风险和预后。
方法
利用丹麦的行政登记数据，比较 SLE 患者（1996 年至 2018 年诊断，无心血管疾病史）和来自背景人群的年龄、性别和共病匹配对照者（1:4 匹配）的结局风险。此外，比较 SLE 患者发生 HF 后的死亡率和年龄及性别匹配的非 SLE 合并 HF 患者（1:4 匹配）。
结果
共纳入 3411 例 SLE 患者（中位年龄：44.6 岁[25 至 75 百分位数：31.9 至 57.0 岁]；14.1%为男性），并匹配了 13644 例对照者。中位随访时间为 8.5 年（25 至 75 百分位数：4.0 至 14.4 年）。结局的绝对 10 年风险为：HF 为 3.71%（95%置信区间[CI]：3.02%至 4.51%），SLE 患者为 1.94%（95%CI：1.68%至 2.24%）；心房颤动为 4.35%（95%CI：3.61%至 5.18%），SLE 患者为 2.82%（95%CI：2.50%至 3.16%）；缺血性卒中和心肌梗死均为 3.75%（95%CI：3.06%至 4.54%），SLE 患者为 1.92%（95%CI：1.66%至 2.20%）；静脉血栓栓塞为 6.03%（95%CI：5.17%至 6.98%），SLE 患者为 1.68%（95%CI：1.44%至 1.95%）；植入式心脏复律除颤器植入/室性心律失常/心搏骤停的复合结局为 0.89%（95%CI：0.58%至 1.31%），SLE 患者为 0.30%（95%CI：0.20%至 0.43%）。与无 SLE 的 HF 相比，SLE 伴随后发生的 HF 与更高的死亡率相关（校正后的危险比：1.50；95%CI：1.08 至 2.08）。
结论
SLE 患者发生 HF 和其他心血管结局的风险高于匹配的对照者。在发生 HF 的患者中，SLE 病史与更高的死亡率相关。
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