Systemic lupus erythematosus (SLE) is associated with high rates of atherosclerotic cardiovascular disease (CVD), and recent research has shown SLE patients may have a higher risk of CVD than patients with diabetes mellitus. Diabetes mellitus is considered an independent CVD risk factor, and as such aggressive risk assessment with lipid screenings and treatment with statins are used to decrease patient morbidity and mortality.
Some have advocated for this aggressive management of CVD risk with annual assessments in SLE patients. However, studies have shown that provisions of care based on these recommendations may be suboptimal. New research from Sarah K. Chen, MD, and colleagues from Brigham and Women’s Hospital, Boston, sheds light on the use of aggressive CVD management in SLE patients.
Using patient information from Medicaid Analytic extract, the study examined the rates of lipid testing and dispensing of prescriptions for statins in SLE patients and compared them to patients with diabetes mellitus and Medicaid recipients who had neither disease. Each SLE patient was matched for age and sex with two patients with diabetes mellitus and four people in the general Medicaid population. The cohorts comprised 25,950 SLE patients, 51,900 diabetes mellitus patients and 103,800 Medicaid recipients.
Researchers then used multivariable logistic regression to calculate the odds of lipid testing and treatment with statins and conditional logistic regression to compare the cohorts. The findings were published in January Arthritis Care & Research.
The Results
“Despite having an elevated risk of CVD, SLE patients received less lipid testing and received fewer statin prescriptions compared with age-and sex-matched diabetes mellitus patients and individuals in the general Medicaid population,” write the authors.
Researchers found SLE patients in this large Medcaid cohort had more prevalent CVD at baseline compared with age-and sex-matched patients with diabetes mellitus. And, despite recommendations for annual CVD risk assessment, only 24% of Medicaid beneficiaries with SLE in this study received lipid testing during 1-year follow-up. Only 11% of these SLE patients received statin prescriptions.
Additionally, SLE patients were 66% less likely to have lipid testing and 82% less likely to receive a statin prescription during 1-year follow-up. SLE patients were also less likely to fill a statin prescription compared with individuals in the general Medicaid population with neither disease.
The authors conclude, “Care for the prevention of CVD in SLE patients receiving Medicaid is not consistently provided, and efforts should be made to establish and disseminate clear evidence-based guidelines to improve care and outcomes in this high-risk population.”