title: Risk of Cerebrovascular Accidents and Ischemic Heart Disease in Cutaneous Lupus Erythematosus: A Population-Based Cohort Study.
abstract: It is unclear whether isolated cutaneous lupus erythematosus (CLE) affects cardiovascular risk. We estimated the cumulative incidence and mortality of cardiovascular diseases in a population-based CLE cohort and compared the risk with a matched non-CLE cohort.
  
  
  
  All incident cases of CLE in Olmsted County, Minnesota, between 1965 and 2005 were followed until December 2013. The cumulative incidence of cerebrovascular accidents (CVAs [including stroke and transient ischemic attack]), ischemic heart disease (IHD [including coronary artery disease, myocardial infarction, and angina pectoris]), heart failure, and peripheral arterial disease (PAD) was derived and compared to an age-, sex-, and calendar year-matched non-CLE cohort using Cox models.
  
  
  
  There were 155 patients with CLE (mean ± SD age at diagnosis 48 ± 16 years, 65% female, mean ± SD BMI 26.3 ± 7.1 kg/m2, 40% smokers, 9% with diabetes mellitus). During a median followup of 14.6 years, 41 CLE patients had cardiovascular events (15 patients with CVAs, 32 patients with IHD), with a 20-year cumulative incidence of 31.6%. As compared to non-CLE subjects, the risk of CVAs (smoking-adjusted hazard ratio [HR] 2.97 [95% confidence interval (95% CI) 1.13-7.78]) and PAD (HR 2.06 [95% CI 0.99-4.32]) was increased in patients with CLE, but the risk of IHD was not increased (HR 0.94 [95% CI 0.57-1.54]). There was no increase in cardiovascular mortality (HR 1.68 [95% CI 0.76-3.75]). The magnitude of risk for any cardiovascular outcome was not significantly influenced by the extent of cutaneous involvement.
  
  
  
  CLE may be associated with an increased risk of CVAs and PAD, but not IHD. Factors contributing to increased CVA risk in patients with CLE merit evaluation.
authors.affiliation: Mayo Clinic, Rochester, Minnesota, and University of California, San Diego.
authors.forename: Abha G
authors.initials: AG
authors.lastname: Singh
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: University of California, San Diego.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.forename: Mark
authors.initials: M
authors.lastname: Denis
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: P
authors.initials: P
authors.lastname: Davis
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Hilal
authors.initials: H
authors.lastname: Maradit-Kremers
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: Mayo Clinic, Rochester, Minnesota. chowdhary.vaidehi@mayo.edu.
authors.forename: Vaidehi R
authors.initials: VR
authors.lastname: Chowdhary
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008178:Lupus Erythematosus, Cutaneous / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology*; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*