Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark.
Clin Rheumatol. 2022 Nov;41(11):3525-3536. doi: 10.1007/s10067-022-06302-z. Epub 2022 Jul 30.
Autoimmune diseases, including systemic lupus erythematosus, have been associated with a substantial risk of cardiovascular morbidity and mortality. However, data on the long-term risk of incident heart failure and other adverse cardiovascular outcomes among patients diagnosed with cutaneous lupus erythematosus (CLE) are limited.
In this cohort study, all patients ≥ 18 years with newly diagnosed CLE between 1996 and 2018 were identified through Danish nationwide registries and matched 1:4 by age, sex, and comorbidity with individuals without CLE. Incident adverse cardiovascular outcomes, including heart failure, were compared between the matched groups, overall, and according to sex.
Of 2085 patients diagnosed with CLE, 2062 patients were matched with 8248 control subjects from the Danish background population (median age 50 years [25th-75th percentile: 37-62 years]; 22.3% men). The median follow-up was 6.2 years. The 10-year cumulative incidences and adjusted hazard ratios (HR) of outcomes were as follows: heart failure: 3.29% (95% CI, 2.42-4.36%) for CLE patients versus 2.59% (2.20-3.02%) for the background population, HR 1.67 (95% CI, 1.24-2.24); atrial fibrillation or flutter: 5.15% (3.99-6.52%) versus 3.84% (3.37-4.36%), HR 1.40 (1.09-1.80); the composite of ICD implantation, ventricular arrhythmia, or cardiac arrest: 0.72% (0.34-1.40%) versus 0.44% (0.29-0.64%), HR 1.71 (0.85-3.45); the composite of pacemaker implantation, atrioventricular block, or sinoatrial dysfunction: 0.91% (0.48-1.59%) versus 0.54% (0.37-0.76%), HR 1.32 (0.72-2.41); myocardial infarction: 3.05% (2.18-4.15%) versus 1.59% (1.29-1.93%), HR 2.15 (1.53-3.00); ischemic stroke: 3.25% (2.38-4.32%) versus 2.50% (2.13-2.93%), HR 1.56 (1.16-2.10); and venous thromboembolism: 2.74% (1.94-3.75%) versus 2.05% (1.71-2.44%), HR 1.60 (1.16-2.21). Sex did not modify the association between CLE and adverse cardiovascular outcomes (P ≥ 0.12 for all outcomes).
Patients with CLE had a higher associated risk of adverse cardiovascular outcomes compared with the background population, irrespective of sex. Key Points • Findings: In this nationwide cohort study, including 2062 patients with cutaneous lupus erythematosus and 8248 matched controls, cutaneous lupus erythematosus was associated with an increased long-term risk of heart failure, cardiac arrhythmias, and thromboembolic events, irrespective of sex.
包括系统性红斑狼疮在内的自身免疫性疾病与心血管发病率和死亡率有很大关系。然而，关于确诊为皮肤红斑狼疮（CLE）的患者发生心力衰竭和其他不良心血管结局的长期风险的数据有限。
在这项队列研究中，通过丹麦全国性登记册确定了 1996 年至 2018 年期间新诊断为 CLE 的所有患者≥18 岁，并通过年龄、性别和合并症与无 CLE 的个体进行 1:4 匹配。比较了匹配组的总体和按性别比较的不良心血管结局（包括心力衰竭）的发生率。
在 2085 名确诊为 CLE 的患者中，有 2062 名患者与丹麦背景人群中的 8248 名对照者相匹配（中位年龄 50 岁[25 至 75 百分位数：37 至 62 岁]；22.3%为男性）。中位随访时间为 6.2 年。10 年累积发生率和调整后的结局风险比（HR）如下：心力衰竭：CLE 患者为 3.29%（95%CI，2.42-4.36%），背景人群为 2.59%（2.20-3.02%），HR 1.67（95%CI，1.24-2.24）；心房颤动或扑动：5.15%（3.99-6.52%）比 3.84%（3.37-4.36%），HR 1.40（1.09-1.80）；ICD 植入、室性心律失常或心脏骤停的复合症：0.72%（0.34-1.40%）比 0.44%（0.29-0.64%），HR 1.71（0.85-3.45%）；起搏器植入、房室传导阻滞或窦房结功能障碍的复合症：0.91%（0.48-1.59%）比 0.54%（0.37-0.76%），HR 1.32（0.72-2.41%）；心肌梗死：3.05%（2.18-4.15%）比 1.59%（1.29-1.93%），HR 2.15（1.53-3.00%）；缺血性卒：3.25%（2.38-4.32%）比 2.50%（2.13-2.93%），HR 1.56（1.16-2.10%）；静脉血栓栓塞：2.74%（1.94-3.75%）比 2.05%（1.71-2.44%），HR 1.60（1.16-2.21%）。性别并未改变 CLE 与不良心血管结局之间的关联（所有结局的 P≥0.12）。
与背景人群相比，CLE 患者发生不良心血管结局的风险更高，且与性别无关。
研究发现：在这项包括 2062 例皮肤红斑狼疮患者和 8248 例匹配对照的全国性队列研究中，皮肤红斑狼疮与心力衰竭、心律失常和血栓栓塞事件的长期风险增加有关，无论性别如何。
