Cardiovascular events and risk in patients with systemic lupus erythematosus: Systematic literature review and meta-analysis

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease that typically affects women aged 16–55 years. Cardiovascular disease (CVD) is a well-recognized complication of SLE. This systematic literature review and meta-analysis evaluated the relative risk (RR; compared with non-SLE controls), absolute risk (AR; as incidence proportion, n/N), and incidence rate (IR) of CVD events (including stroke, myocardial infarction [MI], and CVD [composite or undefined]) in adult patients with SLE. The RR of CV risk factors (including hypertension, diabetes, and metabolic syndrome [MetS]) was also examined. METHODS: PubMed and Embase were searched on September 10, 2020. Observational studies published between January 2010 and September 2020 that reported RR, AR, and/or IR of CVD events, or RR of CV risk factors, were eligible. Pooled risk estimates were calculated using a random-effects model. RESULTS: Forty-six studies (16 cross-sectional, 15 retrospective cohort, 14 prospective cohort, and 1 case–control) were included in meta-analyses. Most studies were considered high quality (Critical Appraisal Skills Programme checklists). Compared with adults without SLE, patients with SLE had statistically significantly higher RRs (95% CIs) of stroke (2.51 [2.03–3.10]; 12 studies), MI (2.92 [2.45–3.48]; 11 studies), CVD (2.24 [1.94–2.59]; 8 studies), and hypertension (2.70 [1.48–4.92]; 7 studies). RRs of diabetes (1.24 [0.78–1.96]; 3 studies) and MetS (1.49 [0.95–2.33]; 7 studies) were elevated but not significant. RRs of stroke and MI were generally higher in younger versus older patients with SLE. In patients with SLE, the pooled estimate of AR (95% CI) was 0.03 (0.02–0.05), 0.01 (0.00–0.02), and 0.06 (0.03–0.10) for stroke (7 studies), MI (6 studies), and CVD (8 studies), respectively. The pooled estimate of IR per 1000 person-years (95% CI) was 4.72 (3.35–6.32), 2.81 (1.61–4.32), and 11.21 (8.48–14.32) for stroke (10 studies), MI (6 studies), and CVD (8 studies), respectively. Although heterogeneity (based on I(2) value) was high in most analyses, sensitivity analyses confirmed the robustness of the pooled estimates. CONCLUSIONS: This meta-analysis found an increased risk of stroke, MI, CVD, and hypertension in patients with SLE compared with the general population, despite substantial heterogeneity across the included studies.