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. 2025 Feb 1;161(2):175-182.
doi: 10.1001/jamadermatol.2024.4991.

Incidence and Prevalence of Atherosclerotic Cardiovascular Disease in Cutaneous Lupus Erythematosus

Henry W Chen  1 , Jialiang Liu  2 , Donghan M Yang  2 , Yang Xie  2 , Eric D Peterson  3 , Ann Marie Navar  3 , Benjamin F Chong  1
Affiliations

Incidence and Prevalence of Atherosclerotic Cardiovascular Disease in Cutaneous Lupus Erythematosus

Henry W Chen et al. JAMA Dermatol. .

Abstract

Importance: Autoimmune diseases such as systemic lupus erythematosus (SLE) and psoriasis have been previously associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Whether similar increased ASCVD risk is seen with cutaneous lupus erythematosus (CLE) remains unclear.

Objective: To evaluate the incidence and prevalence of ASCVD among those with CLE, SLE, and psoriasis compared with a disease-free control group.

Design, setting, and participants: This retrospective, matched longitudinal cohort study used data from January 2018 to December 2020 in the IBM MarketScan Commercial Claims and Encounters Database. The control population included individuals free of CLE, SLE, and psoriasis, matched 10:1 with the CLE population on age, sex, insurance type, and enrollment duration. Data were analyzed from September 2022 to April 2024.

Main outcomes and measures: Prevalent ASCVD was defined as coronary artery disease, prior myocardial infarction, or cerebrovascular accident. Incident ASCVD was assessed through the number of hospitalization events through the end of follow-up (up to 3 years) in each group. Multivariable logistic regression and Cox proportional hazards models were performed to compare the prevalence and incidence of ASCVD between exposure groups, adjusting for age, sex, and cardiovascular risk factors.

Results: A total of 8138 persons with CLE (median [IQR] age, 49 [40-47] years; 6618 [81%] female), 24 675 with SLE (median [IQR] age, 46 [36-54] years; 22 432 [91%] female), 192 577 persons with psoriasis (median [IQR] age, 48 [36-56] years; 106 631 [55%] female), and 81 380 control individuals (49 [40-57] years; 66 180 [81%] female) were identified. In multivariable analysis, the odds of ASCVD were higher than control for CLE (odds ratio [OR], 1.72 [95% CI, 1.45-2.02]; P < .001) and SLE (OR, 2.41 [95% CI, 2.14-2.70]; P < .001), but not psoriasis (OR, 1.03 [95% CI, 0.95-1.11]; P = .48). At median 3 years follow-up, incidence rates of ASCVD were highest for SLE (24.8 [95% CI, 23.3-26.4] per 1000 person-years), followed by CLE (15.2 [95% CI, 13.1-17.7] per 1000 person-years), psoriasis (14.0 [95% CI, 13.5-14.4] per 1000 person-years), and then controls (10.3 [95% CI, 9.77-10.94] per 1000 person-years). In multivariable Cox proportional regression modeling with the control group as a reference group, the highest risk of incident ASCVD was in those with SLE (hazard ratio [HR], 2.23 [95% CI, 2.05-2.43]; P < .001), followed by CLE (HR, 1.32 [95% CI, 1.13-1.55]; P < .001), and psoriasis (HR, 1.06 [95% CI, 0.99-1.13]; P = .09).

Conclusions and relevance: In this retrospective matched longitudinal cohort study, CLE was associated with an increased risk for ASCVD, similar to the risk in SLE but higher than the risk in psoriasis. The role of comorbidities that augment ASCVD risk like smoking status should be further investigated. Clinicians treating patients with CLE can consider them at increased ASCVD risk and institute appropriate screening tests.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Peterson reported grants from Amgen, personal fees from Janssen, personal fees from Novo Nordisk, and grants from Esperion during the conduct of the study. Dr Navar reported personal fees from Amgen, Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Eli Lilly, Esperion, Janssen, Merck, New Amsterdam, Novartis, Novo Nordisk, Pfizer, Pfizer, Roche, Silence Therapeutics and grants from Amgen, Esperion, Janssen, BMS outside the submitted work. Dr Navar is also the Deputy Editor, Diversity, Equity, and Inclusion, at JAMA Cardiology. Dr Chong reported personal fees from Biogen Incorporated Consultant/Investigator, personal fees from Bristol Meyers Squibb Consultant, personal fees from EMD Serono Consultant, personal fees from Amgen Incorporated Consultant, personal fees from Lupus Research Alliance Consultant, and other from MAPI Research Trust Royalties outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Multivariable Adjusted Odds of Atherosclerotic Cardiovascular Disease (ASCVD) in Cutaneous Lupus Erythematosus (CLE), Psoriasis, and Systemic Lupus Erythematosus (SLE)
Multivariable logistic regressions were performed to identify odds ratios (ORs) of ASCVD in persons with CLE, psoriasis, and SLE compared with disease-free controls. Composite ASCVD and individual components of ASCVD, including myocardial infarction, cerebrovascular accident, and coronary artery disease were analyzed. Models were adjusted for traditional comorbidities associated with ASCVD, including age, sex, hypertension, diabetes, obesity, chronic kidney disease, dyslipidemia, and time observed. P values less than .05 were considered statistically significant.
Figure 2.
Figure 2.. Atherosclerotic Cardiovascular Disease (ASCVD) Incidence Over Time in Cutaneous Lupus Erythematosus (CLE), Controls, Psoriasis, and Systemic Lupus Erythematosus (SLE)
Kaplan-Meier survival curves were stratified by persons with CLE, SLE, psoriasis, and controls. Persons were censored after the first instance of ASCVD or if no further follow-up was available. The shaded portions denote 95% CIs. The number at risk and cumulative number censored in 120-day increments are shown in the tables beneath the survival curves.
Figure 3.
Figure 3.. Multivariable Adjusted Hazard Ratios (HRs) of Atherosclerotic Cardiovascular Disease (ASCVD) in Cutaneous Lupus Erythematosus (CLE), Psoriasis, and Systemic Lupus Erythematosus (SLE)
Multivariable Cox proportional hazards regression was performed to identify HRs of ASCVD in persons with CLE, psoriasis, and SLE compared with disease-free controls. Adjusted HRs are presented as forest plots. The primary outcome was composite ASCVD as defined by any of the following conditions: myocardial infarction, cerebrovascular accident, or coronary artery disease. Each component of the composite outcome is presented separately. Models were adjusted for traditional comorbidities associated with ASCVD, including age, sex, hypertension, diabetes, obesity, chronic kidney disease, and dyslipidemia. The control group served as the reference group and is not shown. P values less than .05 were considered statistically significant.
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