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Patients with systemic lupus erythematosus have a higher incidence of cardiovascular disease than the general population. Antihypertensive drugs that modify the renin-angiotensin system (RAS) are used to protect renal function in lupus nephritis and may also have extrarenal effects that lower cardiovascular disease risk due to their anti-inflammatory properties. In this study, we compared the effects of RAS versus non-RAS antihypertensive drugs on cardiovascular disease incidence in patients with lupus .Using a medical insurance claims dataset, 220,168 patients with lupus were identified, of which 31,647 patients (4,018 patients prescribed RAS drugs, 27,629 patients prescribed non-RAS drugs) were eligible for the study. Patients had a mean age of 46.1 years, 93.0% female, and healthy (96.9% Charlson Comorbidity Index score 0-4). Patients in the two drug groups were propensity score matched using demographic data, risk factors, and comorbidities.Use of RAS versus non-RAS drugs lowered the relative risk (RR) of diagnosis of cardiovascular disease (RR 0.80, 95% CI [0.74-0.87]), which was more pronounced after propensity score matching (RR 0.62, 95% CI [0.57-0.68]). The decreased risk in cardiovascular disease occurred regardless of lupus nephritis status (with lupus nephritis: RR 0.51, 95% CI [0.39-0.65]; without lupus nephritis: RR 0.65, 95% CI [0.59-0.72]). RAS-modifying therapies significantly increased cardiovascular disease-free survival probability over a 5-year period (86.0% versus 78.3% probability).RAS-modifying drugs reduced the risk of cardiovascular disease in patients with systemic lupus erythematosus in this dataset. These findings have the potential to impact clinical decision making with regards to hypertension management in patients with lupus. |
