Antimalarial Use in SLE May be Cardioprotective

Patients with systemic lupus erythematosus (SLE) and congestive heart failure (CHF) experience more severe SLE, but treatment with antimalarials was associated with a lower prevalence of CHF, according to a study published in Seminars in Arthritis and Rheumatism.¹

“Patients with SLE and CHF experience more severe SLE, with more pronounced cumulative damage, higher overall SLE-related mortality, and greater refractoriness to SLE treatments,” stated Iñigo Rúa-Figueroa, MD, Hospital Universitario de Gran Canaria Doctor Negrin, Spain, and colleagues. “Treatment with antimalarials, as usually administered in patients with SLE, is not only safe for the heart, but might confer cardioprotective effects.”

Despite the high prevalence of cardiovascular disease in patients with SLE, the risk factors associated with CHF in these patients is not well studied.

In this cross-sectional study, the researchers aimed to identify the factors associated with CHF in patients with SLE and looked at the cardiac safety of long-term therapy with hydroxychloroquine in this population. The study included 117 patients with SLE and CHF and 3,506 SLE control patients registered in the retrospective phase of the Spanish Society of Rheumatology Lupus Register who met at least 4 of the American College of Rheumatology (1997) criteria. Of the participants, 90% were female and 93% were Caucasian. The study excluded patients with CHF prior to diagnosis of SLE.

Results showed that patients with CHF presented with greater SLE severity, organ damage, and mortality when compared with those without CHF. The mean age of patients with CHF was higher than the controls without CHF, at 59.8 years and 46.2 years, respectively. Meanwhile, factors associated with CHF were ischemic heart disease, cardiac arrhythmia, pulmonary hypertension, valvulopathy,non-cardiovascular damage, and calcium/vitamin D treatment. However, female sex and antimalarial use were found to be protective.

Investigators determined that CHF is a late complication of SLE and is linked with high mortality rates. Causes of CHF in SLE were similar to causes seen in the general population.

“The use of antimalarials was associated with a lower prevalence of CHF in our large multicenter retrospective SLE cohort, and, interestingly, this effect occurred independently of disease severity,” investigators concluded. “This apparently cardioprotective effect was also documented independently of ischemic heart disease, suggesting that mechanisms other than antithrombotic effects could be involved, for example, better control of subclinical myocarditis or overall disease activity.”

Reference:

Rúa-Figueroa I, Rúa-Figueroa D, Pérez-Veiga N, et al. Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure.Semin Arthritis Rheum (Journal pre-proof). Jan 2 2022. https://doi.org/10.1016/j.semarthrit.2021.11.012