Premium
Maternal Hypertensive Disorders in Pregnant Women With Systemic Lupus Erythematosus and Future Cardiovascular Outcomes
Author(s) -
Simard Julia F.,
Rossides Marios,
Arkema Elizabeth V.,
Svenungsson Elisabet,
Wikström AnnaKarin,
Mittleman Murray A.,
Salmon Jane E.
Publication year - 2021
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24160
Subject(s) - medicine , hazard ratio , preeclampsia , incidence (geometry) , pregnancy , proportional hazards model , population , cohort , disease , systemic lupus erythematosus , confidence interval , biology , optics , genetics , physics , environmental health
Objective Hypertensive disorders of pregnancy (HDPs) increase cardiovascular disease (CVD) risk. Pregnancy morbidities, including preeclampsia and CVD, are common in systemic lupus erythematosus (SLE). Possible connections are important to explore. In a population‐based cohort, we investigated whether HDPs are associated with a higher risk of cardiovascular outcomes separately in women with SLE and those without SLE to examine the role of SLE. Methods We identified first singleton births in the Medical Birth Register (1987–2012) among mothers with SLE and a large general population comparison group. Discharge diagnoses for HDPs, cardiovascular outcomes, and hypertension in the National Patient Register were identified using International Classification of Diseases codes. We estimated adjusted hazard ratios and 95% confidence intervals of the association between HDPs and outcomes in separate models in women with and without SLE. We then evaluated additive and multiplicative effect modification using relative excess risk due to interaction and Cox models jointly accounting for SLE and HDPs, respectively. Mediation analysis estimated the proportion of the association between SLE and outcome explained by HDPs. Results HDPs were more common in pregnant women with SLE (20% versus 7%). In SLE, HDPs were associated with a 2‐fold higher rate of cardiovascular outcomes and a 3‐fold higher rate of incident hypertension. HDPs mediated 20% of the latter association. In women without SLE, HDPs were associated with higher incidence of hypertension later in life. Conclusion In women with SLE and those without SLE, HDPs were associated with a 3‐fold higher rate of hypertension. In SLE, women with HDPs developed cardiovascular outcomes twice as often as women without HDPs.