title: Cardiovascular disease a hazard despite improved prognosis in patients with systemic lupus erythematosus: results from a Swedish population based study 1964-95.
abstract: OBJECTIVE
  Although short term prognosis has improved in patients with systemic lupus erythematosus (SLE) during the early disease course, less is known about the longterm prognosis.
  
  
  METHODS
  A cohort of 4737 patients with a diagnostic code of SLE was identified 1964-94 in the Swedish Hospital Discharge Register and followed by linkage to the Cause of Death Register until the end of 1995. Mortality was separately analyzed in 3 different calendar periods (1964-75, 1975-84, 1985-95). The relative risk of death was estimated as standardized mortality ratio (SMR) using the Swedish population as a reference.
  
  
  RESULTS
  In total 2314 patients were deceased. Mortality was 3-fold increased (SMR = 3.63, 95% CI 3.49, 3.78) and cardiovascular disease (CVD) was the major cause of death. Patients aged 20-39 years at the first discharge had a 16-fold increased risk of death from coronary heart disease (SMR = 15.99, 95% CI 10.4, 23.6). All-cause mortality had decreased since 1975 and the reason for this decrease was entirely due to a decrease in causes attributed to SLE, but not CVD. Patients aged 20-39 years at the first discharge had a pronounced decrease in mortality, with SMR 33.59 (95% CI 24.3, 45.3) before 1975 compared with SMR 14.23 (95% CI 8.70, 22.0) after 1984.
  
  
  CONCLUSIONS
  Cardiovascular disease was the major cause of death in patients with SLE and young patients had a pronounced increased risk of death. Even if all-cause mortality had declined during the last 2 decades due to causes attributed to SLE, the risk of cardiovascular death remained unchanged.
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden. lena.bjornadal@medks.ki.se
authors.forename: Lena
authors.initials: L
authors.lastname: Björnådal
authors.forename: Li
authors.initials: L
authors.lastname: Yin
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Lars
authors.initials: L
authors.lastname: Klareskog
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology