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Risk of Cerebrovascular Accidents and Ischemic Heart Disease in Cutaneous Lupus Erythematosus: A Population-based Cohort Study #MMPMID27015109
Arthritis Care Res (Hoboken) 2016[Nov]; 68 (11): 1664-70 PMID27015109show ga
Objective: It is unclear whether isolated cutaneous lupus erythematosus (CLE) modifies cardiovascular risk. We estimated the cumulative incidence and mortality of cardiovascular diseases in a population-based CLE cohort, and compared the risk with a matched non-CLE cohort. Methods: All incident cases of CLE in Olmsted County, Minnesota between 1965?2005 were followed until December 2013. Cumulative incidence of cerebrovascular accidents (CVA, including stroke, transient ischemic attack), ischemic heart disease (IHD, including coronary artery disease, myocardial infarction, angina), heart failure, and peripheral arterial disease was derived and compared to an age-, sex- and calendar-year-matched non-CLE cohort using Cox models. Results: There were a total of 155 patients with CLE (age at diagnosis, 48±16 years; 65% females; BMI, 26.3±7.1 kg/m2; 40% smokers, 9% with diabetes). During median follow-up of 14.6 years, 41 CLE patients developed cardiovascular events (15 patients with CVA, 32 patients with IHD), with a 20-year cumulative incidence of 31.6%. As compared to non-CLE subjects, the risk of CVAs (smoking-adjusted hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.13?7.78) and PAD (HR, 2.06; 95% CI, 0.99?4.32) was increased in patients with CLE, but risk of IHD was not increased (HR, 0.94; 95% CI, 0.57?1.54). There was no increase in cardiovascular mortality (HR, 1.68; 95% CI, 0.76?3.75). The magnitude of risk for any cardiovascular outcome was not significantly influenced by extent of cutaneous involvement. Conclusion: CLE may be associated with an increased risk of CVA and PAD, but not IHD. Factors contributing to increase CVA risk in patients with CLE merit evaluation.