November 12, 2023
3 minute read
SAN DIEGO ā Pregnant women with systemic lupus erythematosus and antiphospholipid syndrome have an 18-fold increased risk of cardiovascular events compared to healthy pregnant controls, speakers at ACR Convergence 2023 said.
“Autoimmune rheumatic diseases and pregnancy are both known to increase the risk of cardiovascular events.” Dr. Rashmi Dhital, a professor at the University of California, San Diego, told Helio. “However, there is limited research focusing on the impact of autoimmune rheumatic diseases on the risk of cardiovascular events during pregnancy and the early postpartum period.”
Dital added that there is a lack of comparisons between different diseases across the rheumatology spectrum that focus on cardiovascular outcomes during pregnancy.
“We conducted this study to comprehensively understand the range of risk for cardiovascular events in autoimmune rheumatic diseases, focusing on a specific population of pregnant women,” she said. “To put our findings into context, we looked at similar findings in primary antiphospholipid syndrome (APS), another autoimmune disease known to be associated with cardiovascular risks and events. We also looked at the risk of vascular events.ā
To this end, Dhital et al. compared the outcomes of 19,340 pregnant women with autoimmune rheumatic diseases with those of the general population of pregnant women without autoimmune rheumatic diseases. Eligible participants were those who gave birth to singleton infants in California between 2005 and 2020. Data linking birth certificates to maternal discharge, emergency department, and outpatient surgery records were obtained from the California Maternal and Infant Outcomes Study.
Cardiovascular events identified by ICD code and reported up to 6 weeks postpartum were included in the analysis. Autoimmune rheumatic diseases and APS were identified using his ICD codes as well. The researchers used logistic regression to calculate adjusted RRs and also used mediation analysis to find that pregnancy complications such as gestational diabetes and preeclampsia were associated with autoimmune rheumatic diseases and cardiovascular events. It was determined whether the relationship between
Among patients with autoimmune rheumatic diseases, 7,758 had APS. The control group, on the other hand, included more than 7 million pregnant patients without autoimmune rheumatic diseases.
The results showed that cardiovascular events occurred in 2% of pregnant women with autoimmune rheumatic diseases, 6.9% of patients with primary APS, and 0.4% of healthy controls.
Compared with the general pregnant population, acute cardiac The risk of vascular events was significantly higher. , 13.5-16.0), according to the researchers.
“Patients with autoimmune rheumatic diseases have a higher frequency of traditional cardiovascular risk factors and are at four times higher risk of cardiovascular events,” said Dr. Dytal.
Women with SLE had more than six times the incidence of cardiovascular events compared to the general population. The risk in this group was further increased by the comorbidity of APS (aRR = 18.1) or nephritis (aRR = 12.7).
Further investigation revealed that 12% of the excess risk of acute cardiovascular events in the autoimmune rheumatic disease group was mediated by preeclampsia, compared with 1% for events mediated by gestational diabetes, according to the researchers. It was revealed that less than
Additionally, evaluation of readmission records showed that approximately 25% to 30% of cardiovascular events occurred postpartum. The researchers noted that this rate was six times higher in the autoimmune rheumatoid disease group than in the control group.
“In our study, about a quarter of cardiovascular events occur in the early postpartum period, so close follow-up and continued vigilance is needed even after delivery,” said Dietal.
āFuture research will focus on risk stratifying cardiovascular events, investigating patient-, disease-, and treatment-specific characteristics that contribute to increased risk of cardiovascular events, and developing pharmacotherapies and other preventive strategies to reduce this risk.ā We need to focus on studying effectiveness,” he added.
Additional research is also needed to understand the broader impact of cardiovascular events on adverse pregnancy outcomes and later disease risk in children and adults, Dhital said. He added that there is a need to develop strategies to effectively monitor and manage cardiovascular risks and events in rheumatology patients.
āThis should include disease-specific cardiovascular risk screening and management guidelines, biomarker discovery, cost-effective imaging, and enhanced practices such as electronic medical record alerts,ā said Dytal. Stated. “Adding cardiovascular risk screening and management to the American College of Rheumatology’s existing reproductive health guidelines will be beneficial for patients who are pregnant or considering pregnancy.”
Individual rheumatologists also have a role in helping patients with these complications. “Managing traditional risk factors that are more common in autoimmune rheumatic diseases and primary APS may help reduce some of the risk of maternal cardiovascular events in these groups. Yes,ā Detar said. “Maternal cardiovascular risk varied by disease and was higher even after adjusting for traditional risk factors. This highlights the importance of considering individual patient profile, disease, and treatment-related factors to tailor care.” It shows.ā
āDiagnosis can be difficult in younger patients because cardiovascular events are less likely and symptoms overlap with normal pregnancy, so rheumatologists collaborate with other medical teams, such as obstetrics and cardiology, to treat this important disease.ā “We need to manage these complications,” he added.
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Dhital R. Abstract 722. Presentation location: ACR Convergence 2023; November 10-15, 2023. San Diego.
Disclosure: Dhital does not report any relevant financial disclosures.