But the likelihood of CVD is still higher in systemic lupus erythematosus.
Clinicians have been urged to consider cardiovascular risk factors in patients with cutaneous lupus erythematosus, as new research suggests patients are at twice the risk.
An increased risk of atherosclerotic cardiovascular disease is an unfortunate reality for people with chronic, inflammatory autoimmune diseases such as psoriasis or systemic lupus erythematosus. Yet much less is known about the association between atherosclerotic cardiovascular disease and cutaneous lupus erythematosus.
Now a new retrospective longitudinal cohort study of patients with cutaneous lupus, systemic lupus and psoriasis suggests patients with cutaneous lupus and systemic lupus are 1.3 and 2.2 times more likely to develop atherosclerotic cardiovascular disease compared to disease free controls, while psoriasis patients were not found to have an increased risk.
“These data suggest that cutaneous lupus erythematosus can be considered a risk enhancer for atherosclerotic cardiovascular disease, and comprehensive cardiovascular risk reduction strategies can be beneficial for persons with cutaneous lupus erythematosus,” the researchers wrote in JAMA Dermatology.
US researchers used data from a commercial claims and encounters database to identify roughly 8000 people with cutaneous lupus, 25,000 people with systemic lupus, 190,000 people with psoriasis and 80,000 people with none of these conditions. Patients with cutaneous/systemic lupus or psoriasis were matched with disease free controls based on age, sex, geographic region and insurance type, among other factors.
After adjusting for age and sex, as well as the presence of hypertension, diabetes, obesity, chronic kidney disease and dyslipidaemia, patients with systemic lupus were 2.4 times more likely and patients with cutaneous lupus were 1.7 times more likely to also have atherosclerotic cardiovascular disease, defined as myocardial infarction, a cerebrovascular accident or coronary artery disease, compared to controls. There was no association between psoriasis and atherosclerotic cardiovascular disease.
Patients with systemic and cutaneous lupus but no prior history of atherosclerotic cardiovascular disease were also 2.2 and 1.3 times more likely to develop new onset atherosclerotic cardiovascular disease compared to disease free controls after controlling for the same factors mentioned above. Again, there was no increase in the likelihood of developing atherosclerotic cardiovascular disease in patients with psoriasis.
Within the cutaneous lupus cohort, a greater proportion of the patients receiving systemic therapy went on to develop atherosclerotic cardiovascular disease (2%) compared to those receiving topical therapy or no therapy at all (2% each), although the researchers highlighted one potential explanation for this finding.
“Those taking systemic therapy were older and higher rates of cardiovascular risk factors, so differences in event rates are likely driven by patient characteristics – not the therapies themselves. It is likely that those with more severe disease were more likely to receive systemic therapies,” they wrote.
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The researchers also noted that the association between cutaneous lupus and atherosclerotic cardiovascular disease was most likely multifactorial.
“Cutaneous lupus erythematosus may increase atherosclerotic cardiovascular disease risk directly via inflammatory pathways, such as the prominent interferon signature that has been observed in cutaneous lupus, that promote atherosclerosis,” they wrote.
“Indirectly, cutaneous lupus erythematosus may increase the prevalence of other intermediate risk factors for cardiovascular disease such as metabolic syndrome, diabetes and obesity.”
However, the results of the study must be interpreted with caution, as researchers were unable to control for the effects of smoking, blood pressure or cholesterol on the association between cutaneous lupus and atherosclerotic cardiovascular disease – three factors known to increase the risk of the latter. In addition, the current study only looked at three years of data, when it may take longer for the full effects of atherosclerotic cardiovascular disease to emerge.
Despite these limitations, the researchers emphasised the need for better surveillance and prevention of atherosclerotic cardiovascular disease in people with cutaneous lupus.
“This may include improved monitoring of blood pressure and prompt treatment of hypertension, regular measurement of serum cholesterol and initiation of statin therapy in those at otherwise intermediate risks of events,” they concluded.
“In addition, promoting a healthy lifestyle, including not smoking, eating a healthy diet and engaging in regular physical activity should be foundational for health promotion in persons with cutaneous lupus erythematosus.”
