Systemic lupus erythematosus and the risk of cardiovascular disease: Results from the nurses' health study

Authors

  • A. Elisabeth Hak,

    Corresponding author
    1. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
    2. Erasmus MC University Medical Center, Rotterdam, The Netherlands
    • Academic Medical Center, Division of Clinical Immunology & Rheumatology, EULAR & FOCIS Center of Excellence, Meibergdreef 9, F4-129, 1105 AZ Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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    • Dr. Hak is recipient of an Erasmus MC Fellowship (Erasmus MC University Medical Center, Rotterdam, The Netherlands) and was supported by the Foundation “Vereniging Trustfonds Erasmus Universiteit Rotterdam,” The Netherlands.

  • Elizabeth W. Karlson,

    1. Brigham and Women's Hospital, Boston, Massachusetts
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  • Diane Feskanich,

    1. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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  • Meir J. Stampfer,

    1. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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  • Karen H. Costenbader

    1. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
    2. Erasmus MC University Medical Center, Rotterdam, The Netherlands
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    • Dr. Costenbader is recipient of an Arthritis Foundation/American College of Rheumatology Arthritis Investigator award and a Katherine Swan Ginsburg Memorial award.


Abstract

Objective

Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular disease. However, prospective population-based data addressing this association have been lacking.

Methods

We conducted a prospective cohort study among 119,332 women participating in the Nurses' Health Study who were free of cardiovascular disease and SLE at baseline in 1976. Incident SLE was confirmed by medical record review. Cardiovascular events included fatal and nonfatal myocardial infarction, stroke, coronary artery bypass grafting, and angioplasty. The relative risk (RR) of cardiovascular events among participants with SLE as compared with those without SLE was estimated using Cox proportional hazards models.

Results

Over 28 years of followup (2.9 million person-years), 8,169 cardiovascular events occurred and 148 women developed incident SLE. The mean age at SLE diagnosis was 52.6 years, and 20 participants with SLE developed a subsequent cardiovascular event. After adjusting for potential confounding factors, including age, race, cardiovascular risk factors, and medication use, the RR of a cardiovascular event in women with SLE compared with those without SLE was 2.26 (95% confidence interval [95% CI] 1.45–3.52). When end points were analyzed separately, the RR for coronary heart disease was 2.25 (95% CI 1.37–3.69) and the RR for stroke was 2.29 (95% CI 0.85–6.15).

Conclusion

In this prospective population-based study, we found a statistically significant >2-fold increased risk of cardiovascular disease among participants with SLE. The risk was not as high as has been previously reported, which may have been due to the relatively high age at diagnosis of SLE in this cohort.

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