Dziedzic Radosław, Węgiel Michał, Siwiec-Koźlik Andżelika, Spałkowska Magdalena, Zaręba Lech, Bazan-Socha Stanisława, Korkosz Mariusz, Kosałka-Węgiel Joanna
Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, św. Łazarza 16, 31-530 Kraków, Poland.
University Hospital in Kraków, 2nd Department of Cardiology, Jakubowskiego 2, 30-688 Kraków, Poland.
J Clin Med. 2025 Jun 3;14(11):3920. doi: 10.3390/jcm14113920.
Systemic lupus erythematosus (SLE) is an autoimmune disease associated with an increased prevalence of cardiac and cerebrovascular events. Despite advancements in management, no validated tools exist that can predict the risk of ischemic stroke in SLE patients. However, several studies have demonstrated an association between a higher CHADS-VASc score and an enhanced risk of ischemic stroke in autoimmune diseases without atrial fibrillation (AF) or atrial flutter (AFL). Recently, the European Society of Cardiology suggested the use of a revised score of CHADS-VASc without taking sex into account (CHADS-VA). Therefore, we sought to check if the new CHADS-VA score might predict stroke or other cardiovascular events in SLE patients without AF/AFL. : We retrospectively analyzed the records of patients with SLE treated at the University Hospital in Kraków, Poland, from 2012 to 2022. Patients with a history of AF/AFL were excluded. : This study enrolled 787 SLE patients without AF/AFL (aged 49 (38-60) years) with a predominance of women ( = 705, 89.58%). Common comorbidities included arterial hypertension ( = 376, 47.78%) and hypercholesterolemia ( = 345, 43.84%). Most non-AF/AFL SLE patients had 0-1 points in the CHADS-VA score ( = 514, 65.31%). Overall, ischemic stroke occurred in 47 cases during a median follow-up of 8 (4-17) years regarding time from the SLE diagnosis to the stroke, with the incidence rising from 0% ( = 0/297) to 28% ( = 14/50) as the CHADS-VA score increased from 0 to ≥5 points. No ischemic strokes or other thromboembolic events occurred among the 575 (73.06%) patients with a CHADS-VA score of 0-2 points. In the whole cohort, patients with ≥3 points in the CHADS-VA score ( = 212, 26.94%) were older at the last visit, had longer disease duration, were more commonly of the male sex, and were diagnosed more frequently with ischemic stroke or other thromboembolic events in their medical history ( < 0.05, for all) compared to those with 0-2 points ( = 575, 73.06%). However, in multivariable logistic regression, among the CHADS-VA components, only older age (≥50 years) was related to the increased risk of thromboembolic complications (OR = 2.09, 95% CI: 1.36-3.22). Other determining factors included the presence of lupus anticoagulant (OR = 3.39, 95% CI: 2.20-5.27) and neurological SLE symptoms (OR = 2.19, 95% CI: 1.19-4.02). Interestingly, male sex (OR = 0.34, 95% CI: 0.22-0.52) and general SLE symptoms (OR = 0.43, 95% CI: 0.28-0.67) were associated with a decreased risk of thromboembolic events in this model ( = 0.034, for the model). : SLE-related factors seem important for the onset of thromboembolic episodes. However, a higher CHADS-VA score may also help to identify SLE patients with an increased risk of cardiovascular events, including stroke. Prospective studies with a long-term analysis need to be validated using the CHADS-VA score to predict stroke risk in SLE patients.
系统性红斑狼疮（SLE）是一种自身免疫性疾病，与心血管和脑血管事件的患病率增加相关。尽管在治疗方面取得了进展，但尚无经过验证的工具可预测SLE患者发生缺血性中风的风险。然而，多项研究表明，在无房颤（AF）或房扑（AFL）的自身免疫性疾病中，较高的CHADS-VASc评分与缺血性中风风险增加之间存在关联。最近，欧洲心脏病学会建议使用不考虑性别的修订版CHADS-VASc评分（CHADS-VA）。因此，我们试图检验新的CHADS-VA评分是否可预测无AF/AFL的SLE患者发生中风或其他心血管事件。：我们回顾性分析了2012年至2022年在波兰克拉科夫大学医院接受治疗的SLE患者的记录。排除有AF/AFL病史的患者。：本研究纳入了787例无AF/AFL的SLE患者（年龄49（38 - 60）岁），女性占多数（n = 705，89.58%）。常见合并症包括动脉高血压（n = 376，47.78%）和高胆固醇血症（n = 345，43.84%）。大多数无AF/AFL的SLE患者CHADS-VA评分为0 - 1分（n = 514，65.31%）。总体而言，在从SLE诊断到中风的中位随访8（4 - 17）年期间，47例发生了缺血性中风，随着CHADS-VA评分从0增加到≥5分，发病率从0%（n = 0/297）升至28%（n = 14/50）。CHADS-VA评分为0 - 2分的575例（73.06%）患者中未发生缺血性中风或其他血栓栓塞事件。在整个队列中，CHADS-VA评分≥3分的患者（n = 212，26.94%）在最后一次就诊时年龄更大，病程更长，男性更常见，且在其病史中更频繁地被诊断为缺血性中风或其他血栓栓塞事件（与评分为0 - 2分的患者（n = 575，73.06%）相比，所有p < 0.05）。然而，在多变量逻辑回归中，在CHADS-VA各组成部分中，只有年龄较大（≥50岁）与血栓栓塞并发症风险增加相关（OR = 2.09，95%CI：1.36 - 3.22）。其他决定因素包括狼疮抗凝物的存在（OR = 3.39，95%CI：2.20 - 5.27）和神经精神性SLE症状（OR = 2.19，95%CI：1.19 - 4.02）。有趣的是，在该模型中，男性（OR = 0.34，95%CI：0.22 - 0.52）和一般性SLE症状（OR = 0.43，95%CI：0.28 - 0.67）与血栓栓塞事件风险降低相关（模型p = 0.034）。：SLE相关因素似乎对血栓栓塞发作的发生很重要。然而，较高的CHADS-VA评分也可能有助于识别心血管事件风险增加的SLE患者，包括中风。需要通过前瞻性研究进行长期分析，以验证使用CHADS-VA评分预测SLE患者中风风险的有效性。
