Background Systemic lupus erythematosus (SLE) is associated with an increased cardiovascular (CV) risk (1). By retrospectively investigating a one centre cohort, we have recently reported that low-dose aspirin (ASA) use is associated with a reduced CV risk in SLE (2) and long-term hydroxychloroquine (HCQ) exposure may have an additive effect (3).
Objectives This study was conducted on 2 Italian SLE cohorts to confirm these results and assess the role, if any, of statins.
Methods Clinical charts of SLE patients consecutively admitted to 2 University Rheumatology Units from November 2000 to December 2014 who, at admission, had not experienced any CV event, were investigated. ASA, HCQ and statins use and the occurrence of any CV event, were recorded at each visit. Kaplan-Meier analysis was performed to determine the HCQ exposure status associated with a higher CV-free survival. Cox regression analysis was carried out to identify factors independently associated with a first CV event.
Results A total of 291 SLE patients were included in the study and followed for a median of 8 years. During follow-up, 16 CV events occurred. Kaplan Meier analysis revealed a greater CV event-free rate in the 120 ASA-treated patients taking HCQ at standard dose for more than 5 years than in the 98 patients treated with ASA alone or with HCQ for less than 5 years (Figure 1). At univariate analysis, patients with a first CV event compared with those without any thrombotic events were antiphospholipid antibody (aPL) positive (P=0.017 HR 2.91) and had significantly higher blood pressure (P=0.017 HR 3.58), hypercholesterolemia (P=0,015 HR 3.40) and higher disease damage at last visit (P=0,032 HR 1.56). Moreover, ASA treatment (P=0,012 HR 0.27) and HCQ use (P=0,012 HR 0.26) for more than 5 years were negative predictors, while statins use did not show any association (P=0.619). All other variables examined, including smoking, obesity, hypertriglyceridaemia, diabetes mellitus, disease activity, severe SLE, other medications (immunosuppressive agents, steroids) were not associated, either positively or negatively, with the occurrence of CV events. At multivariate analysis, taking ASA and HCQ for more than 5 years were protective against thrombosis (HR 0.24 and HR 0.27, respectively), while aPL positivity (HR 4.32) increased the risk of a first CV event.
Conclusions Use of antimalarials for more than 5 years is associated with a reduced risk of a first thrombosis in SLE patients and the HCQ-ASA combination seems to synergistically reduce further the CV risk. Larger, prospective studies are needed to provide a better definition of the role of these drugs in CV primary prevention in SLE.
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Iudici M, et al. Low-dose aspirin as primary prophylaxis for cardiovascular events in systemic lupus erythematosus: a long-term retrospective cohort study. RheumatolOxfEngl 2016.
Fasano S, et al. Long-Term Hydroxychloroquine Therapy and Low-Dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol 2016.
Disclosure of Interest None declared