A recent study in The Journal of Rheumatology sheds light on the importance of preconceptional cardiovascular health in women with systemic lupus erythematosus. Although many questions remain, improved cardiovascular health measures seem to positively affect pregnancy outcomes, suggesting a potential role for preconception cardiovascular interventions.1
Women with lupus now have healthier pregnancies than in the past, but pregnancy still poses an increased risk for certain problems for mother and child, including preeclampsia, postpartum infection, thromboembolic disease, spontaneous abortion and issues resulting from preterm delivery and small-for-gestational-age infants.2 Estimates of the prevalence of infants born preterm or small-for-gestational age put the risk at two to six times higher in lupus patients than in the general population.1
Women with lupus are also at a fivefold increased risk of significant cardiovascular events than those without the disease.3 The cardiovascular risk factors of hypertension, dyslipidemia and obesity appear to be relatively common comorbidities in lupus patients and may be more common than in the population at large.1,3 Yet these factors alone may not fully account for the increased risk in these patients, because often, younger patients without traditional risk factors seem to be at the greater risk of such events.3 Moreover, previous studies have shown that pregnancy complications, such as those resulting in a small-for-gestational-age infants, may increase the later risk of cardiovascular mortality in lupus patients.4
Amanda Eudy, PhD, is an assistant professor of medicine at Duke University, Durham, N.C., and first author of the recent study. “It’s an important topic for the health of the infant and the impact of the pregnancy,” she explains, noting the impetus for the study.
“It also has long-term implications for the overall health of the mother. Since cardiovascular events are more prevalent in lupus patients compared to the general population anyway, perhaps improving cardiovascular health at an earlier age—during those reproductive years, could have a long-term impact on improving their health overall.”
For the study, Dr. Eudy and colleagues used data from the Hopkins Lupus Pregnancy Cohort, which began to study pregnant lupus patients as a prospective cohort in 1987. Ultimately, 309 lupus pregnancies were analyzed (from 261 lupus patients). The research team focused its efforts on the cardiovascular health impact goals elucidated by the American Heart Association (AHA).5 Data for three of these factors were available: total cholesterol, blood pressure and body mass index (BMI). Data were collected from the year prior to conception or from the first trimester if preconception data were not available.
Poor cholesterol health was defined as greater than or equal to 240 mg/dL; intermediate health as 200–239 mg/dL or treated to goal; ideal health as less than 200 mg/dL. For blood pressure, poor health was defined as systolic greater than or equal to 140 mmHg or diastolic greater than or equal to 90 mmHg; intermediate health as between 120 and 139 mmHg systolic or between 80 and 89 mmHg diastolic or treated to goal; ideal health as less than 120 mmHg systolic and less than 80 mmHg diastolic. For BMI, obese was defined as greater than or equal to 30 kg/m2; overweight as between 25 and 30 kg/m2; ideal as less than 25 kg/m2.
To account for confounding variables, Dr. Eudy and colleagues included covariates in their analysis, including race, age, education, disease duration, medication use, renal involvement and organ damage at conception. Using ANOVA, Fisher’s exact test and regression models, the researchers analyzed differences in the prevalence of preterm birth, small-for-gestational-age infants, mean gestational age and mean birth weight for gestational age z-score.