Assessing Heart Disease and Stroke Risk in Systemic Lupus Erythematosus (SLE)
Previous work from ARC demonstrated that people with SLE have a 1000% increase in the risk of heart attack and stroke. SLE is the biggest cause of heart attack and stroke identified to date. Certain risk factors are known to increase the chance of heart attack or stroke in the general population, that is people without SLE. These include being a man, having a raised blood sugar (diabetes mellitus), having a high blood level of fats such as cholesterol, smoking, having high blood pressure, and having a strong history of heart disease or stroke in the family. Because of the increased risk of heart attack and stroke in SLE, it was decided to check how often the known factors that increase heart attack and stroke were checked for in SLE.
A review of medical charts from a lupus clinic and five private practices was conducted to see how often it was documented that a person with SLE did or did not have these risk factors and whether or not definitive action was taken. A total of 183 charts of individuals with SLE were studied.
Relevance For People With Arthritis:
There have now been a number of studies which suggest that doctors are not checking persons with SLE for heart disease risk factors as much as one might expect based on the recent scientific reports of a greatly increased risk of heart attack and stroke among people with SLE. This study concluded that much more needs to be done and that physicians need to be more aggressive in both looking for heart disease and doing something about abnormal levels of risk factors. People with SLE and similar disorders should have a blood pressure check, a diabetes check, a cholesterol check, and a check of another blood substance, homocysteine, as well as reducing weight and stopping smoking. The removal of these risk factors by treatment, stopping smoking, losing weight, and so on has been shown in the general population to protect against heart disease and stroke. This research attracted public interest because of its high relevance to the individual with SLE. Recent work suggests that rheumatoid arthritis also has a higher risk of heart disease and stroke, although less than for SLE. Many of these same lessons should be applied to individuals with rheumatoid arthritis.
Only a third of the medical charts documented that a cholesterol test had been performed. Half of the cholesterol tests that were performed were at least slightly abnormal, but in only the minority was a definite action taken. Blood pressure, blood sugar and smoking were charted in more than half of the records. Obesity was recorded in a third. Only 1/16 of the records noted the presence or absence of a family history of heart disease. It must be kept in mind that the fact that information is not written down in the medical chart does not mean that it was not obtained or that it was not obtained by another physician, such as the family doctor.
2000 – 2001 Funding Agency: Arthritis Research Canada
Publications / Presentations
- Al-Herz A, Ensworth E, Shojania K, Esdaile JM. Cardiovascular risk factor screening in SLE. J Rheumatol 2003;30:493-6.
- Esdaile, JE, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, Cote R, Grover SA, Fortin PR, Clarke AE, Senecal J-L. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001;10:2331-7.
Project Team Members:
Adeeba Al Herz MBBS, FRCPC, ABIM Rheumatology Fellow, Division of Rheumatology University of British Columbia Arthritis Research Centre of Canada
Stephanie Ensworth MD, FRCPC Division of Rheumatology University of British Columbia Kamran Shojania MD , FRCPC Director, Clinical Trials, ARC Division of Rheumatology, University of British Columbia Clinical Educator Scholar, Arthritis Society of Canada John M. Esdaile MD MPH, FRCPC Scientific Director, ARC Professor and Head, Division of Rheumatology, University of British Columbia