ATHEROSCLEROTIC cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality worldwide, with autoimmune conditions such as systemic lupus erythematosus (SLE) and psoriasis previously linked to elevated ASCVD risk. However, the relationship between ASCVD and cutaneous lupus erythematosus (CLE), a subtype of lupus affecting the skin, remains less clear. This retrospective longitudinal cohort study aimed to assess the prevalence and incidence of ASCVD in individuals with CLE compared to those with SLE, psoriasis, and a disease-free control group. Data were obtained from the IBM MarketScan Commercial Claims and Encounters Database between January 2018 and December 2020, with analysis conducted from September 2022–April 2024.
The study included 8138 individuals with CLE, matched with 24,675 persons with SLE, 192,577 with psoriasis, and 81,380 disease-free controls based on age, sex, insurance type, and enrollment duration. At baseline, the prevalence of ASCVD was significantly higher in persons with CLE (odds ratio [OR], 1.72) and SLE (OR, 2.41) compared to controls, while psoriasis did not show a significant increase (OR, 1.03). This indicates that CLE shares a notable ASCVD risk profile similar to SLE but distinct from psoriasis.
Over a median three-year follow-up, the incidence of ASCVD was highest in the SLE group (24.8 per 1000 person-years), followed by CLE (15.2), psoriasis (14.0), and controls (10.3). Adjusted multivariable analysis demonstrated that the risk of incident ASCVD remained significantly elevated in CLE (hazard ratio [HR], 1.32) and SLE (HR, 2.23) compared to controls, while psoriasis showed no significant risk increase (HR, 1.06). These findings suggest that CLE is associated with both a higher prevalence and incidence of ASCVD, albeit to a lesser extent than SLE.
Given these results, patients with CLE may benefit from increased vigilance in cardiovascular screening and management. Identifying comorbidities, including smoking and other cardiovascular risk factors, will be crucial in mitigating this elevated risk. Clinicians should consider incorporating appropriate ASCVD screening strategies for patients with CLE, recognising their heightened cardiovascular risk profile and implementing early intervention measures to improve long-term outcomes.
Katie Wright, EMJ
Reference
Chen HW et al. Incidence and prevalence of atherosclerotic cardiovascular disease in cutaneous lupus erythematosus. JAMA Dermatol. 2024;DOI:10.1001/jamadermatol.2024.4991.
