Cardiovascular Disease a Hazard Despite Improved Prognosis in Patients with Systemic Lupus Erythematosus: Results from a Swedish Population Based Study 1964–95

LENA BJÖRNÅDAL, LI YIN, FREDRIK GRANATH, LARS KLARESKOG, and ANDERS EKBOM

ABSTRACT.

Objective. Although short term prognosis has improved in patients with systemic lupus erythematosus (SLE) during the early disease course, less is known about the longterm prognosis.

Methods. A cohort of 4737 patients with a diagnostic code of SLE was identified 1964–94 in the Swedish Hospital Discharge Register and followed by linkage to the Cause of Death Register until the end of 1995. Mortality was separately analyzed in 3 different calendar periods (1964–75, 1975–84, 1985–95). The relative risk of death was estimated as standardized mortality ratio (SMR) using the Swedish population as a reference.

Results. In total 2314 patients were deceased. Mortality was 3-fold increased (SMR = 3.63, 95% CI 3.49, 3.78) and cardiovascular disease (CVD) was the major cause of death. Patients aged 20–39 years at the first discharge had a 16-fold increased risk of death from coronary heart disease (SMR = 15.99, 95% CI 10.4, 23.6). All-cause mortality had decreased since 1975 and the reason for this decrease was entirely due to a decrease in causes attributed to SLE, but not CVD. Patients aged 20–39 years at the first discharge had a pronounced decrease in mortality, with SMR 33.59 (95% CI 24.3, 45.3) before 1975 compared with SMR 14.23 (95% CI 8.70, 22.0) after 1984.

Conclusion. Cardiovascular disease was the major cause of death in patients with SLE and young patients had a pronounced increased risk of death. Even if all-cause mortality had declined during the last 2 decades due to causes attributed to SLE, the risk of cardiovascular death remained unchanged. (J Rheumatol 2004;31:713-9)

Key Indexing Terms:

SYSTEMIC LUPUS ERYTHEMATOSUS
MORTALITY
EPIDEMIOLOGY
CORONARY HEART DISEASE
CARDIOVASCULAR
STROKE

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From the Rheumatology Unit and Clinical Epidemiology Unit, Department of Internal Medicine, Karolinska Hospital, Stockholm; Department of Epidemiology, Karolinska Institutet, Stockholm, Sweden; and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.

Supported by The Heart and Lung Foundation, Sweden.

L. Björnådal, MD; L. Klareskog, MD, PhD, Rheumatology Unit, Karolinska Hospital; L. Yin, PhD; F. Granath, PhD, Department of Epidemiology, Karolinska Institutet; A. Ekbom, MD, PhD, Clinical Epidemiology Unit, Karolinska Hospital, Department of Epidemiology, Harvard School of Public Health.

Address reprint requests to Dr. L. Björnådal, Rheumatology Unit, Karolinska Hospital, SE-171 76 Stockholm, Sweden. E-mail: Lena.Bjornadal@medks.ki.se

Submitted February 12, 2003; revision accepted October 21, 2003.

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