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Risk factors for cardiovascular diseases in patients with systemic lupus erythematosus: an umbrella review

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Abstract

Cardiovascular disease in patients with systemic lupus erythematosus (SLE) remains one of the most common causes of death and is caused by several factors, including both traditional and disease-specific risk factors. We aimed to systematically appraise the evidence of cardiovascular disease risk factors focusing on the SLE population. The protocol for this umbrella review is registered in PROSPERO (registration no. CRD42020206858). A systematic literature search was conducted in PubMed, Embase, and the Cochrane Library from database inception to June 22, 2022, for systematic reviews and meta-analyzes that examined cardiovascular disease risk factors in patients with SLE. Two reviewers independently extracted data and assessed the quality of the included studies using the “Assessing the Methodological Quality of Systematic Reviews 2 (AMSTER 2)” tool. Of the 102 identified articles, nine systematic reviews were included in this umbrella review. All included systematic reviews were assessed as critically low quality according to the AMSTER 2 tool. The traditional risk factors identified in this study were older age, male sex, hypertension, dyslipidemia, smoking, and a family history of cardiovascular disease. SLE-specific risk factors were long-term disease duration, lupus nephritis, neurological disorders, high disease activity, organ damage, use of glucocorticoids, azathioprine, and antiphospholipid antibodies, including anticardiolipin antibodies and lupus anticoagulant. This umbrella review identified some cardiovascular disease risk factors in patients with SLE; however, the study quality of all included systematic reviews was critically low.

Key Points

• We examined the evidence of cardiovascular disease risk factors focusing on patients with systemic lupus erythematosus.

• We found that long-term disease duration, lupus nephritis, neurological disorders, high disease activity, organ damage, use of glucocorticoids, azathioprine, and antiphospholipid antibodies, including anticardiolipin antibodies and lupus anticoagulant, were cardiovascular disease risk factors among patients with systemic lupus erythematosus.

• The review indicates the need for well-validated and high-quality future reviews that assess major adverse cardiovascular events as an outcome in patients with systemic lupus erythematosus.

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Data availability

The datasets used and analyzed in the present study are available from the corresponding author on reasonable request.

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Funding

This study was supported by JSPS KAKENHI (grant number: JP20K18962).

Author information

Authors and Affiliations

  1. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan

    Yu Katayama & Yoshia Miyawaki

  2. Division of Rheumatology, Department of Medicine, Showa University Graduate School of Medicine, Tokyo, Japan

    Ryo Yanai

  3. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Takahiro Itaya

  4. Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Yusuke Nagamine

  5. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Kyosuke Tanigawa

Authors
  1. Yu Katayama
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  2. Ryo Yanai
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  3. Takahiro Itaya
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  4. Yusuke Nagamine
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  5. Kyosuke Tanigawa
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  6. Yoshia Miyawaki
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Contributions

Study concept and design: YK, RY, TI, YN and YM. Data collection: YK, RY, TI, YN, KT and YM. Writing: YK, RY and TI. All authors critically revised the report, commented on drafts of the manuscript, and approved the final version.

Corresponding author

Correspondence to Yoshia Miyawaki.

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Ethics approval

This study did not require ethical approval because we analyzed only published results and did not include patients.

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Katayama, Y., Yanai, R., Itaya, T. et al. Risk factors for cardiovascular diseases in patients with systemic lupus erythematosus: an umbrella review. Clin Rheumatol 42, 2931–2941 (2023). https://doi.org/10.1007/s10067-023-06608-6

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  • DOI: https://doi.org/10.1007/s10067-023-06608-6

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