Long-term risk of adverse cardiovascular outcomes associated with cutaneous lupus erythematosus: a nationwide cohort study

Background Autoimmune diseases, including systemic lupus erythematosus, have been associated with a substantial risk of cardiovascular morbidity and mortality. However, data on the long-term risk of incident heart failure and other adverse cardiovascular outcomes among patients diagnosed with cutaneous lupus erythematosus (CLE) are limited. Methods In this cohort study, all patients ≥ 18 years with newly diagnosed CLE between 1996 and 2018 were identified through Danish nationwide registries and matched 1:4 by age, sex, and comorbidity with individuals without CLE. Incident adverse cardiovascular outcomes, including heart failure, were compared between the matched groups, overall, and according to sex. Results Of 2085 patients diagnosed with CLE, 2062 patients were matched with 8248 control subjects from the Danish background population (median age 50 years [25th–75th percentile: 37–62 years]; 22.3% men). The median follow-up was 6.2 years. The 10-year cumulative incidences and adjusted hazard ratios (HR) of outcomes were as follows: heart failure: 3.29% (95% CI, 2.42–4.36%) for CLE patients versus 2.59% (2.20–3.02%) for the background population, HR 1.67 (95% CI, 1.24–2.24); atrial fibrillation or flutter: 5.15% (3.99–6.52%) versus 3.84% (3.37–4.36%), HR 1.40 (1.09–1.80); the composite of ICD implantation, ventricular arrhythmia, or cardiac arrest: 0.72% (0.34–1.40%) versus 0.44% (0.29–0.64%), HR 1.71 (0.85–3.45); the composite of pacemaker implantation, atrioventricular block, or sinoatrial dysfunction: 0.91% (0.48–1.59%) versus 0.54% (0.37–0.76%), HR 1.32 (0.72–2.41); myocardial infarction: 3.05% (2.18–4.15%) versus 1.59% (1.29–1.93%), HR 2.15 (1.53–3.00); ischemic stroke: 3.25% (2.38–4.32%) versus 2.50% (2.13–2.93%), HR 1.56 (1.16–2.10); and venous thromboembolism: 2.74% (1.94–3.75%) versus 2.05% (1.71–2.44%), HR 1.60 (1.16–2.21). Sex did not modify the association between CLE and adverse cardiovascular outcomes ( P interaction ≥ 0.12 for all outcomes). Conclusions Patients with CLE had a higher associated risk of adverse cardiovascular outcomes compared with the background population, irrespective of sex. Key Points • Findings: In this nationwide cohort study, including 2062 patients with cutaneous lupus erythematosus and 8248 matched controls, cutaneous lupus erythematosus was associated with an increased long-term risk of heart failure, cardiac arrhythmias, and thromboembolic events, irrespective of sex.