ACR: Lupus Patients Need Lipid Screening
ATLANTA -- Patients with systemic lupus erythematosus -- and particularly women -- are not routinely being screened for lipids, despite their widely recognized risk for cardiovascular disease, a researcher said here.
Among women in a lupus inception cohort, only 60% had ever had the standard lipid screening recommended by the U.S. Preventive Services Task Force, which is every five years for all adults, according to Christie M. Bartels, MD, of the University of Wisconsin in Madison, and colleagues.
In comparison, 85% of the men in the cohort had received lipid screening at some point.
Furthermore, among the entire cohort of 71 patients, only 20% had ever received a diagnosis of hyperlipidemia, Bartels reported in a poster session at the annual meeting of the American College of Rheumatology.
"What's more, even though 43% met the criteria for being given a statin, only 11% ever had been prescribed one of these drugs," she told MedPage Today.
Clear guidelines have yet to be formulated for lipid screening among patients with lupus, although some have suggested that serum lipids should be measured annually.
A previous study found that highly sensitive C-reactive protein (CRP) also could be used in a non-lupus population to determine if statin treatment to reduce cardiovascular risk is warranted.
To examine current practice in screening for both lipids and CRP for patients with lupus, and to estimate hazards of cardiovascular events related to these factors, Bartels' group initiated a retrospective cohort study of 71 incident lupus cases diagnosed between 1991 and 2008.
Mean age of participants was 52, 82% were women, and they had been followed for a mean of 7.7 years.
At baseline, 12% were smokers, 24% had hypertension, 13% had dyslipidemia, and 7% had diabetes.
Ischemia had already been diagnosed in 16% and congestive heart failure in 10%; 4% had had a stroke and 3% had had an MI.
Past drug therapies included steroids in 73%, hydroxychloroquine in 75%, and disease modifying drugs in 25%.
Among those who had been screened for lipids, 72% had LDL cholesterol levels greater than 100 mg/dL, and 43% had levels exceeding 130 mg/dL.
Testing was more common for CRP than for lipids, at 75% of the cohort, and an elevated level had been found at some point in 49%, and a current elevated level was seen in 30%.
When the researchers looked at lipid and CRP screening and risk of a cardiovascular event, they found that elevated CRP, but not elevated LDL, was associated:
- •CRP elevated >1 mg/L at any time, HR 3.31 (95% CI 1.17 to 9.33, P=0.02)
- •CRP elevated >1 mg/L currently, HR 4.33 (95% CI 1.68 to 11.2, P<0.01)
As to why associations were not seen for LDL, Bartels explained that this was not a time series analysis and the confidence intervals were wide.
The study also was limited by the small patient population, the fact that the researchers did not control for CRP and lipid monitoring, and the small number of patients who received statins.
These findings suggest that better coordination is needed between specialists and primary care physicians, who are more attuned to concerns such as dyslipidemia.
"There tends to be a diffusion of care for patients with lupus across multiple clinics and caregivers, and efforts will be needed to close the gaps in screening for patients with lupus," Bartels concluded.
Source: American College of Rheumatology Conference 2010