New research published in Rheumatology, the international, peer-reviewed scientific journal, has suggested that systemic lupus erythematosus (SLE) patients of African descent and from lower socioeconomic groups face a higher risk of primary cardiac disease. However, those taking anti-malarial drugs reduce their risk.
The research found that 14% of patients experience cardiac problems as a result of the auto-immune disorder within five years of diagnosis. It also suggests that particular factors can increase or reduce patients’ risk of pericarditis, valvular heart disease, arrhythmias, myocarditis and/or endocarditis.
Using records for an international cohort of more than 1,400 patients from 34 centres across nine Latin American countries, the study tracked patients who were newly diagnosed with SLE between 1997 and 2005. The research identified that those of African ancestry and those in lower socioeconomic groups have a higher risk of cardiac problems, with odds ratios of 1.82 and 1.80 respectively. Existing research has also identified African ancestry as a risk factor for cardiac problems in SLE patients in the UK.
Cardiac problems can arise at any time during the course of SLE but gender, age at disease onset and education were not associated with increased risk. Those being treated with anti-malarial drugs were also found to have a reduced risk, with an odds ratio of 0.49.
The research stated: “The most remarkable observation of the present study was the recognition that the use of anti-malarials had a protective effect over the later occurrence of primary cardiac disease. This finding extends the list of the beneficial effects of anti-malarials in lupus besides disease activity, flares, overall damage, renal survival and mortality.”
Bernardo Pons-Estel, lead researcher for the study, said: “Considering that anti-malarials are available around the world at a relatively modest cost, this finding is quite relevant. In addition it is important to point out that given that some cardiovascular manifestations are silent, physicians should systematically investigate them using non-invasive and sensitive tests, so they can be treated appropriately.”
Dr Chris Deighton, President of the British Society for Rheumatology, said: “This reminds us that the diseases rheumatologists look after affect much more than joints, muscles and bones, and can also affect vital organs such as the heart. Certain patients with lupus seem to be more prone than others, but treating the underlying inflammation and immune disturbance can make a big difference to the overall health of these patients. All patients with lupus should be under the ongoing surveillance of a rheumatology multidisciplinary team.”
Professor Jaap van Laar, editor of Rheumatology, said: “Multinational cohort studies are vital for clinical practice and this comprehensive study from Latin America is unique in its scope and depth, providing a detailed analysis of the link between cardiovascular co-morbidity and lupus and the beneficial effects of anti-malarials.”
Primary cardiac disease in systemic lupus erythematosus patients: protective and risk factors-data from a multi-ethnic Latin American cohort, Mercedes A. García, Graciela S. Alarcón, Gabriela Boggio, Leticia Hachuel, Ana Inés Marcos, Juan Carlos Marcos, Silvana Gentiletti, Francisco Caeiro, Emilia I. Sato, Eduardo F. Borba, João C. Tavares Brenol, Loreto Massardo, José Fernando Molina-Restrepo, Gloria Vásquez, Marlene Guibert-Toledano, Leonor Barile-Fabris, Mary-Carmen Amigo, Guillermo F. Huerta-Yáñez, Jorge M. Cucho-Venegas, Rosa Chacón-Diaz and Bernardo A. Pons-Estel, Rheumatology, DOI: 10.1093/rheumatology/keu011, published online 14 March 2014.