Abstract
Background
Patients with systemic lupus erythematosus have a higher incidence of cardiovascular
disease than the general population. Antihypertensive drugs that modify the renin-angiotensin
system (RAS) are used to protect renal function in lupus nephritis and may also have
extrarenal effects that lower cardiovascular disease risk due to their anti-inflammatory
properties. In this study, we compared the effects of RAS vs non-RAS antihypertensive
drugs on cardiovascular disease incidence in patients with lupus.
Methods
Using a medical insurance claims dataset, 220,168 patients with lupus were identified,
of which 31,647 patients (4018 patients prescribed RAS drugs, 27,629 patients prescribed
non-RAS drugs) were eligible for the study. Patients had a mean age of 46.1 years,
were 93.0% female, and healthy (96.9% Charlson Comorbidity Index score 0-4). Patients
in the 2 drug groups were propensity score matched using demographic data, risk factors,
and comorbidities.
Results
Use of RAS vs non-RAS drugs lowered the relative risk (RR) of diagnosis of cardiovascular
disease (RR 0.80; 95% confidence interval [CI], 0.74-0.87), which was more pronounced
after propensity score matching (RR 0.62; 95% CI, 0.57-0.68). The decreased risk in
cardiovascular disease occurred regardless of lupus nephritis status (with lupus nephritis:
RR 0.51; 95% CI, 0.39-0.65; without lupus nephritis: RR 0.65; 95% CI, 0.59-0.72).
RAS-modifying therapies significantly increased cardiovascular disease-free survival
probability over a 5-year period (86.0% vs 78.3% probability).
Conclusions
RAS-modifying drugs reduced the risk of cardiovascular disease in patients with systemic
lupus erythematosus in this dataset. These findings have the potential to impact clinical
decision-making with regards to hypertension management in patients with lupus.
Keywords
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Article info
Publication history
Published online: December 07, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: Grant 2P01AG026572 from the National Institute on Aging, Grant 5R25NS107185 from the National Institute of Neurological Disorders and Stroke.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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