Lupus cardiovascular death rate unchanged despite decrease in all-cause mortality

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Apr 15, 2004

Lupus cardiovascular death rate unchanged despite decrease in all-cause

mortality

Stockholm, Sweden - Mortality has declined in systemic lupus erythematosus

(SLE) patients over the past 2 decades, but cardiovascular disease remains

the major cause of death, and the risk of cardiovascular death has not

decreased, Dr Lena Bjornadal reports in the April 2004 issue of the Journal

of Rheumatology [1].

" No change in cardiovascular mortality was evident during the follow-up

period of more than 30 years. "

" Patients with SLE had an increased risk of cardiovascular death, which

remained increased even 20 years after the first discharge. The decrease in

mortality during the last 2 decades was entirely due to a decline in causes

attributable to SLE. Despite this decline in mortality, no change in

cardiovascular mortality was evident during the follow-up period of more

than 30 years, " Bjornadal writes.

Cardiovascular risk especially high in younger patients

The researchers studied a cohort of 4737 patients with SLE identified during

the 1964-1994 period in the Swedish Hospital Discharge Register and followed

by linkage to the Cause of Death Register until the end of 1995. In that

time, 2314 patients died, mortality was triple that in the nonlupus

population, and cardiovascular disease was the major cause of death.

The risk of death from coronary heart disease was 16-fold increased in

patients aged 20 to 39 at the time of discharge after first hospitalization

for lupus. During the first decade after first hospitalization, 59% of

excess deaths were due to causes attributed to SLE and 14% to cardiovascular

disease (CVD). After 10 years, mortality due to SLE decreased to 32%, while

deaths due to CVD rose to 37%.

Mortality began to drop among the SLE patients after 1975, and Bjornadal

points out that this change coincided with a tripling of the number of

rheumatology centers in Sweden as well as with the introduction of new

treatment options, including loop diuretics, antibiotics, and greater

implementation of antihypertensive therapy in lupus patients. The decrease

in mortality was most apparent in younger patients (69% decrease in patients

aged 20 to 29 at first discharge, 42% decrease in patients aged 40 to 59,

and no decrease in older patients). However, the decrease in all-cause

mortality was entirely due to a decrease in causes attributed to SLE. There

were no changes in CVD mortality, which in younger lupus patients remains

about as high as in patients with diabetes.

" The additional risk in the youngest patients implies a multifactorial

pathogenesis in lupus, which might involve genetic as well as traditional

risk factors, " Bjornadal says.

Janis

Source

1. Bjornadal L, Yin L, Granath F, et al. Cardiovascular disease a hazard

despite improved prognosis in patients with systemic lupus erythematosus:

results from a Swedish population based study 1964-1995. J Rheumatol 2004;

31:713-719.