COMMENTARY

Cardiovascular Disease a Leading Cause of Death in Lupus

Kevin Deane, MD

Disclosures

November 17, 2014

Mortality Associated With Systemic Lupus Erythematosus in France Assessed by Multiple-Cause-of-Death Analysis

Thomas G, Mancini J, Jourde-Chiche N, et al
Arthritis Rheumatol. 2014;66:2503-2511

Study Summary

Between 2000 and 2009, a total of 1593 lupus-related deaths were identified in the French Epidemiological Center for the Medical Causes of Death database. The deaths were divided into two groups:

Lupus listed as the underlying cause of death (UCD; n = 637)

Lupus was diagnosed but was not considered the underlying cause of death (NUCD; n = 956).

Overall, the age-standardized mortality ratios in patients with lupus ranged from 2.9 to 4.1 across the 10 years of study, without a substantial reduction over time. For the 637 death certificates on which lupus was listed as the UCD, the other main causes of death were cardiovascular disease (50%), infections (25%), and renal disease (23%); of the cardiovascular diseases, the leading diagnoses were heart failure (20%) and cerebrovascular disease (15%), with such diagnoses as ischemic heart disease and atherosclerosis, each accounting for < 7% of deaths. In particular, excess mortality from cardiovascular and renal disease was highest in patients younger than 40 years and in women, whereas the excess mortality from infections increased with age.

In the 956 patients in whom lupus was present but was reported as a NUCD, cardiovascular disease was still the leading cause of death (36%), followed by cancers (14%) and infections (10%).

Viewpoint

This study strongly supports cardiovascular disease as a leading cause of death in patients with lupus, especially in younger patients. These findings should spur clinicians to monitor their patients carefully and to modify risks when possible. Because the field still is uncertain about which specific modifications will improve outcomes, however, these findings should also prompt researchers to identify interventions that will lead to meaningful improvements in cardiovascular disease among patients with lupus.

An intriguing finding is that the specific cardiovascular diseases that topped the list in patients whose lupus was considered the UCD were heart failure and cerebrovascular disease, whereas ischemic heart disease was much less frequent. With such a high rate of heart failure, one wonders about the possibility of lupus-related myocardial disease, a condition that may be missed in these patients because of the focus on other manifestations of disease.

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