New study conducted with a Swedish lupus cohort finds increased risk of ischemic stroke.
A study published in April 2017 found that lupus patients had more than twice the risk of having an ischemic stroke (HR 2.2, 95% confidence interval 1.7 – 2.8) as the general population. Importantly, the highest relative risk for stroke was in the first year after receiving a lupus diagnosis. The researchers noted that the, “first encounter with patients represents an opportunity for rheumatologists to intervene.”
There were also age and sex differences found in the study. Women and people under the age of 50 experienced the highest relative rate of ischemic stroke. Though, they do note that people over 60 years of age have the highest absolute rate of stroke. And, intra-cerebral hemorrhage was increased for people with SLE, and grew over time. Researchers hypothesized that this may be “due to a cumulative effect of inflammation or medications used more often in SLE such as anticoagulants.“
The participants for this study were found on the Swedish National Patient Registry and controls were identified using the Total Population Register. There were 3,390 people with lupus and 16,730 participants that served as controls in the study, matched on sex, age, and county. 85% of the participants were women.
To be included, participants in the lupus cohort had to be at least 18 years old and have at least two lupus discharge diagnoses, one of which was with a valid specialist.
What is an ischemic stroke?
Ischemic strokes are the most common type of stroke. They are caused by a blood clot that blocks a blood vessel in the brain. This stops the flow of blood to the brain. Blood cells begin to die in minutes. Common symptoms of strokes come on suddenly and include:
- numbness or weakness of the face, arm or leg;
- trouble speaking;
- dizziness or trouble walking;
- loss of balance or coordination
Previous research on ischemic stroke and lupus
This finding of an increased risk of stroke for people with lupus is in line with previous findings. A meta-analysis published in December 2015 in RMD Open found similar results when looking at multiple population-based cohort studies. After analyzing the results from the prior studies, the researchers concluded:
“Individuals with SLE have a twofold higher risk of ischemic stroke, a threefold higher risk of intra-cerebral hemorrhage, and an almost fourfold higher risk of subarachnoid hemorrhage compared to the general population.”
These findings were found in a 28-study systemic review as well. Within that review, there were 4 studies that examined the risk of stroke along with lupus. In total, 9,657 lupus patients experienced 177 events – representing a risk of stroke that was 1.75 times greater than control participants.
What does it mean?
Well stated by researchers in many of these studies, the increased risk of stroke for people with lupus means that clinicians should consider prevention in all conversations regarding treatment. Risk of stroke may be an important factor in care decisions.