1 in 12 Lupus Neprhitis Patients Experience Cardiovascular Events

Patients with lupus nephritis are at a “considerable” risk of cardiovascular events relative to the general population, according to new data presented at the National Kidney Foundation 2024 Spring Clinical Meeting (SCM) in Long Beach, CA, this week.

A team of investigators from Loma Linda University presented a poster showing that, in particular, patients with lupus nephritis plus end-stage kidney disease (ESKD) were susceptible to cardiovascular events including myocardial infarction (MI), stroke or transient ischemic attack. The data also showed a geographical disparity in cardiovascular burdens among patients with lupus, with those in North America reporting a higher prevalence of events and diagnosed disease than their peers in Asia.

The findings are relevant to a discernible trend occurring in recent clinical research; another review and analysis earlier this year observed an increased likelihood of dyslipidemia and hypertension among patients with lupus.

In this latest assessment, investigators led by Mehrbod Vakhshoori, MD, a postdoctoral researcher at Loma Linda, conducted a systematic review and meta-analysis to assess the prevalence of cardiovascular events including MI and cerebrovascular accident (CVA), as well as related deaths, in patients with lupus nephritis. Borne from systemic lupus erythematosus (SLE), lupus nephritis is highly prevalent among women of reproductive age and can associate frequently with premature cardiovascular morbidity, the team noted.

“Patients with SLE are susceptible to various cardiovascular diseases, and previous studies have indicated that LN is associated with a 2.8 to 8.5 times increased risk of cardiovascular events (CVE) among sufferers,” investigators wrote. “Despite a 44% reduction in cardiovascular deaths from the 1995–1999 to 2010–2014 timeframes, the exact pathophysiological mechanisms for CVE development in LN patients remain unknown. Moreover, the true prevalence of CVE in these patients has yet to be elucidated, highlighting the need for comprehensive study.”

Vakhshoori and colleagues conducted their review and analysis to interpret studies assessing the occurrence of cardiovascular events among patients with lupus nephritis. Events were defined as reported MI, heart failure (HF), ischemic heart disease, angina pectoris, and cerebrovascular disease including stroke and transient ischemic attack. They interpreted the pooled prevalence of each event through a random effects model, along with 95% confidence intervals (CIs).

The team additionally sought to define the occurrence rate of cardiovascular events in patients stratified by presence of comorbid ESKD, as well as for the specific prevalence of event types. Their literature review concluded in July 2023.

Investigators identified 18 relevant articles for analysis from an initial screening of 1138 studies. They observed an overall pooled occurrence of cardiovascular events in 8% of patients with lupus nephritis (95% CI, 5 – 13).

Among 9 studies with 30,856 participants that which reported MI as an outcome variable in patients with lupus nephritis, the pooled occurrence of the cardiovascular event was 4% (95% CI, 3 – 5). In another 10 studies with 40,235 participants that included cerebrovascular events, the pooled occurrence of stroke or transient ischemic attack was 5% (95% CI, 4 – 7).

Vakhshoori and colleagues additionally observed a nearly 5-fold increased prevalence of cardiovascular events among patients with lupus nephritis in North America (10.0%; 95% CI, 5.0 – 19.2) versus those in Asia (2.2%; 95% CI, 1.4 – 3.5); in Europe, the occurrence was approximately 4-fold greater (8.2%; 95% CI, 4.3 – 15.0).

Lastly, via 6 articles including 64,958 participants, investigators observed that 8% of patients with ESKD due to lupus nephritis had a cardiovascular event (95% CI, 3 – 19).

“This study underscores the persistent significant occurrence of CVE in individuals with lupus nephritis, despite a decreasing trend in cardiovascular disease rates,” investigators concluded. “These findings emphasize the importance of implementing optimized healthcare management plans to perform appropriate preventive and therapeutic strategies which can effectively result reduction in the burden of lupus nephritis -related CVE and improve outcomes for the affected individuals.”

References

1. ^{Vakhshoori M, Abdipour A, Heidari-Bateni G, Mathew R, et al. Lupus Nephritis and Cardiovascular Events; A Systematic Review and Meta-Analysis. Poster presented at: National Kidney Foundation 2024 Spring Clinical Meeting (SCM). Long Beach, CA. May 14 – 18, 2024.}
2. ^{Campbell P. Lupus Patients with Nephritis at Greater Risk of Cholesterol Disorders, Cardiovascular Events. HCPLive. Published March 24, 2024. https://www.hcplive.com/view/lupus-patients-with-nephritis-at-greater-risk-of-cholesterol-disorders-cardiovascular-events}