Background Young women with systemic lupus erythematosus (SLE) have a higher risk of cardiovascular disease and death from cardiovascular causes (CVDD) even in the absence cardiovascular risk factors.1 Women with SLE are at greater risk of pregnancy complications from placental insufficiency as a result of vasculopathy that manifests clinically as maternal-placental syndrome (MPS).2,3 In unselected populations, the risk of CVDD is increased two-fold in women with previous history of MPS.4 This could be shared pathophysiological processes between MPS and future CVDD that have been unmasked by the stress of pregnancy, or pre-existing cardiac risk factors for more generalised vascular disease that are present in women who develop MPS.5 However, it is not known if MPS increases the risk of future CVDD in the young women with SLE.
Objectives To determine the future risk of CVDD in women with SLE who have had pregnancies complicated by MPS.
Methods Using linked population registries from Sweden, parous women with SLE were identified between 1973-2011. The outcomes of interest were CVDD, this encompassed main cause of death or disease from coronary artery disease (CAD), stroke and peripheral vascular disease (PVD). MPS was defined as pre-eclampsia, small for gestational age (SGA), placental abruption or intrauterine death. Multivariate analysis was performed adjusting for duration of SLE and co-morbidities that were renal disease, hypertension and diabetes.
Results There were 7,410 pregnancies in 3,977 women. Prevalence of cardiovascular disease was 9.0% (n=359) of which CAD accounted for 51.8% (n=186), stroke 43.5% (n=156) and PVD 18.9% (n=68). The median age of onset of cardiovascular disease was 50 years (IQR 41-57). There were 47 women with cardiovascular pathology documented as the main cause of death; CAD accounted for 66.5% (n=31), stroke 23.4% (n=11) and PVD 4.3% (n=2). Median age of death from cardiovascular causes was 53 years (IQR 46-58). Overall, the median age of CVDD was 50 years (IQR 41-57).
The risk of CVDD was not significantly increased in those with a history of MPS (Adjusted OR 1.2; 95%CI 0.9-1.5), but there was a two-fold increase risk of CVDD in women with history of intrauterine deaths (Adjusted OR 1.9; 95%CI 1.1-3.3). These associations were independent of SLE disease status at the time of pregnancy (p>0.05).
Conclusions Unlike reports from the general population, the risk of CVDD in women with SLE was not affected by MPS in pregnancy unless intrauterine death was present.
Urowitz M, et al. J Rheumatol 2007;34:70-75.
Clowse M, et al. Am J Obstet Gynecol. 2008;199:127e1.6.
Magid MS, et al. Am J O&G 1998;179: 226-34.
Bellamy, L, et al. BMJ 2007;335:974.
Magnussen EB, et al. BMJ 2007;335:978.
Acknowledgements The Rose-Hellaby Medical Trust Scholarship and the APLAR Fellowship grant for the support of Dr. May Ching Soh. Ms. Alexandra Gillett for data linkage of the databases.
Disclosure of Interest None declared
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