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Comparative Study
. 2019 Dec;49(3):389-395.
doi: 10.1016/j.semarthrit.2019.06.005. Epub 2019 Jun 11.

Heart failure risk in systemic lupus erythematosus compared to diabetes mellitus and general medicaid patients

Sarah K Chen  1 , Medha Barbhaiya  2 , Michael A Fischer  3 , Hongshu Guan  4 , Kazuki Yoshida  4 , Candace H Feldman  4 , Karen H Costenbader  4 , Brendan M Everett  5
Affiliations
Comparative Study

Heart failure risk in systemic lupus erythematosus compared to diabetes mellitus and general medicaid patients

Sarah K Chen et al. Semin Arthritis Rheum. 2019 Dec.

Abstract

Background: Patients with systemic lupus erythematosus (SLE) have a similar risk of myocardial infarction as those with diabetes mellitus (DM). Whether the risk of heart failure (HF) in SLE is similar to the elevated risk in DM is unknown. We sought to estimate the rates and risks for HF hospitalization among US Medicaid patients with SLE and to compare them to those for DM and the general Medicaid population.

Methods: Using U.S. Medicaid data from 2007-2010, we identified patients with SLE or DM, and a matched cohort from the general Medicaid population and calculated incidence rates (IR), incidence rate ratios (IRR) and adjusted hazard ratios (HR) of a first HF hospitalization.

Results: We identified 37,902 SLE (93% female, mean age 40.1 ± 12.1), 76,657 DM (93% female, mean age 40.0 ± 12.1), and 158,695 general Medicaid patients (93% female, mean age 40.2 ± 12.1). The IR per 1000-person years was 6.9 (95% CI 6.3-7.5) for SLE, 6.6 (95% CI 6.2-7.0) for DM, and 1.6 (95% CI 1.5-1.8) for general Medicaid patients. The highest IRR compared to general Medicaid was seen among SLE patients in age group 18-39 (14.7, 95% CI 13.9-15.5). Multivariable-adjusted HRs for HF compared to general Medicaid population were similar for SLE (2.7, 95% CI 2.3-3.1) and DM (3.0, 95% CI 2.6-3.4).

Conclusion: The incidence of HF among SLE patients was 2.7-fold higher than general Medicaid patients, and similar to DM. Further investigation into the biologic mechanism of HF among SLE compared to non-SLE and DM patients may shed light on the findings of this study.

Keywords: Heart failure; Inflammation; SLE.

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Figures

Figure 1.
Figure 1.. Incidence rate ratios (95% CI) of first hospitalization for heart failure for SLE and DM cohorts with general Medicaid as reference, overall and stratified by covariates
*ASCVD: Baseline presence of any atherosclerotic cardiovascular disease by ICD-9 codes for angina, myocardial infarction, old myocardial infraction, percutaneous coronary intervention, coronary artery bypass graft, atherosclerosis, cerebrovascular accident, peripheral vascular disease, carotid stenosis Abbreviation: ASCVD, atherosclerotic cardiovascular disease; DM, diabetes mellitus; SLE, systemic lupus erythematosus
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