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Abstract
Objective Patients with lupus erythematosus (LE) are at heightened risk for clinical events, chiefly heart attacks and strokes, from atherosclerotic cardiovascular disease (ASCVD). We recently proposed new guidelines to assess and manage ASCVD event risk specifically in LE. Here, we examined current cardiovascular management in light of these new recommendations.
Methods We studied our entire UPenn Longitudinal Lupus Cohort of patients with cutaneous LE, without (CLE-only) or with (CLE+SLE) concurrent systemic LE, for whom we had full access to medical records (n=370, LE-ASCVD Study Cohort).
Results Of our LE-ASCVD Study Cohort, 336/370 (90.8%) had a designated primary-care physician. By the new guidelines, the most recent LDL levels were above-goal for 249/370 (67.3%) (figure 1). Two-hundred sixty-six (71.9%) had hypertension, which was under- or un- treated in 198/266 (74.4%) (figure 2). Of current smokers, 51/63 (81.0%) had no documented smoking cessation counseling or referrals. Diabetes and triglyceridemia were generally well-managed. Of the Cohort, 278 qualified for two widely used online estimators of ASCVD event risk in primary prevention: the ACC-ASCVD Risk Estimator Plus and QRisk3. We also stratified these 278 patients into our recently defined categories of ASCVD event risk in LE. These three methods for estimating ASCVD event risk showed clinically meaningful discordance for 169/278 (60.8%) (figure 3). The documented rate of ASCVD events in the first 10 years after enrollment was 13.5% (95% CI 8.9%, 17.9%), similar between CLE-only and CLE+SLE, indicating an at-risk population despite the preponderance of women and a median age at enrollment of only 47 years (figure 4).
Conclusion Patients with CLE-only or CLE+SLE are under-treated compared with the new guidelines and, accordingly, they experience a significant burden of ASCVD events. Moreover, it is unclear how to accurately assess their future ASCVD event risk, except that it is substantial. Efforts are underway to improve ASCVD event risk estimation and guideline implementation in lupus patients.
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