Background/Purpose: Active inflammatory processes characterize early SLE disease, while later morbidity to a considerable extent consists of consequences of organ damage, particularly cardiovascular disease (CVD). In this study, we report on the frequency of acute myocardial infarctions and stroke in incident SLE cases in a defined population over an extended time.

Methods: The current study includes SLE patients followed at the Department of Rheumatology in Lund, Sweden, diagnosed 1981 through 2006. First, we compare incidence rates of acute myocardial infarctions (AMI) and cerebrovascular incidents (CVI) between all incident SLE cases within 8 counties, through the years 1998-2016, and the population. This time constraint is due to the availability of reliable electronic health care information for the population only from 1998 and forward. Second, we describe AMI and stroke incidence patterns in SLE patients 1981-2016 in an extended cohort. Only the first events of AMI and CVI respectively, both among SLE patients and in the population, were used for calculations.

Results: In all, 276 SLE patients were included in the study. From the defined 8 counties 175 SLE patients were studied and thus 101 patients from outside this region were included. Overall, 38 AMI and 44 CVI were recorded in 72 SLE patients, thus 10 patients had suffered both from an AMI and a CVI. The incidence rate-ratio for AMI was 3.0 in SLE overall (CI 1.3-6.9 (99.9%) p<0.001) compared with the population. Significantly increased rate-ratios of AMI were seen in women <40 and between 40-59 years of age, while for males only the age group 40-59 years had an increased incidence of AMI. SLE patients with a higher age at diagnosis (>54 years) had a shorter disease duration before suffering an AMI compared to SLE patients diagnosed at a younger age (median 7 years vs 18 years, p<0.05). The incidence rate-ratio for CVI in SLE overall was 3.2 (CI 1.6-6.6 (99.9%) p<0.001) compared to the population. An increased CVI incidence was only significant for women in the age group 40-59 years. Males were few and had only 2 events in the higher age group.

Conclusion: SLE patients are at risk of developing early myocardial infarctions and cerebrovascular incidents compared with the population. Patients with a younger age at SLE diagnosis may develop AMI after a longer disease duration compared to older patients.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-disease-in-sle-at-one-center-between-1981-and-2016-a-population-based-study-highlighting-the-importance-of-disease-duration-and-age-at-diagnosis/