Improving Prognosis & Treatment
Previous studies have found patients with SLE are at a higher risk of stroke than the general population, regardless of the type of stroke, and that the relative risk is greater in younger patients.2 These studies show most cases of stroke occurred in the first five years of the disease, particularly during the first year, emphasizing the importance of screening for modifiable risk factors to guide prevention strategies at the time of diagnosis of SLE.
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Explore This IssueMay 2019
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Increasing awareness of the risk of stroke in patients with SLE may help prevent strokes & minimize disability, if the risk is identified early.
Dr. Hanly notes that increasing awareness of the risk of stroke in patients with SLE may help prevent strokes and minimize disability, if the risk is identified early. He recommends screening all patients diagnosed with SLE for traditional cerebrovascular events at the time of diagnosis and annually thereafter.
Dr. Hanly also notes stroke rates are higher in SLE patients of African ancestry. Another recent study, published in Seminars in Arthritis & Rheumatism, showed that certain races were disproportionately affected by cerebrovascular events.3 The study found that black SLE patients in the U.S. are at a 34% higher risk of stroke than white patients, while Hispanics had a 25% greater risk.
The study, conducted by researchers in Boston and New York, identified 65,788 SLE patients between the ages of 18 and 65 and found that after conducting a mean follow-up of 3.7 years, 1,441 first-stroke events were recorded (1,208 ischemic and 233 hemorrhagic). In conducting their analysis, researchers took into account such risk factors as hypertension, heart failure and cardiovascular disease, as well as medication use and sociodemographic factors.
Although the mortality rate for SLE has improved over the past three decades, Dr. Hanly says the mortality rate for lupus patients remains high relative to non-lupus populations.
According to the Centers for Disease Control and Prevention, SLE is the 10th leading cause of death in women ages 15–24 and the fifth leading cause of death for black and Latina women in that cohort.4
“We have one approved biologic currently being used to treat SLE, [and] a number of investigational drugs [are] being tested in clinical trials,” Dr. Hanly says.
As for current treatment guidelines, Dr. Hanly notes that, due to the potential side effects, there isn’t enough evidence to recommend putting all SLE patients at high risk on anticoagulants.
“There are other, safer lifestyle measures that can reduce the risk of stroke, including maintaining a healthy body weight, reducing hypertension, quitting smoking, engaging in regular daily exercise and keeping high cholesterol and diabetes in check,” Dr. Hanly says. “Future studies [may] provide new insights and information that can be used in developing individualized treatment plans.”