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2016 ; 68
(11
): 1664-1670
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Risk of Cerebrovascular Accidents and Ischemic Heart Disease in Cutaneous Lupus
Erythematosus: A Population-Based Cohort Study
#MMPMID27015109
Singh AG
; Crowson CS
; Singh S
; Denis M
; Davis P
; Maradit-Kremers H
; Matteson EL
; Chowdhary VR
Arthritis Care Res (Hoboken)
2016[Nov]; 68
(11
): 1664-1670
PMID27015109
show ga
OBJECTIVE: It is unclear whether isolated cutaneous lupus erythematosus (CLE)
affects 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 and 2005 were followed until December 2013. The
cumulative incidence of cerebrovascular accidents (CVAs [including stroke and
transient ischemic attack]), ischemic heart disease (IHD [including coronary
artery disease, myocardial infarction, and angina pectoris]), heart failure, and
peripheral arterial disease (PAD) was derived and compared to an age-, sex-, and
calendar year-matched non-CLE cohort using Cox models. RESULTS: There were 155
patients with CLE (mean?±?SD age at diagnosis 48?±?16 years, 65% female,
mean?±?SD BMI 26.3?±?7.1 kg/m(2) , 40% smokers, 9% with diabetes mellitus).
During a median followup of 14.6 years, 41 CLE patients had cardiovascular events
(15 patients with CVAs, 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 (95% CI)
1.13-7.78]) and PAD (HR 2.06 [95% CI 0.99-4.32]) was increased in patients with
CLE, but the 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 the extent of cutaneous involvement. CONCLUSION: CLE may be associated with an
increased risk of CVAs and PAD, but not IHD. Factors contributing to increased
CVA risk in patients with CLE merit evaluation.