Current hydroxychloroquine use linked to reduced cardiovascular risk in lupus, RA
Current hydroxychloroquine use in patients with rheumatoid arthritis or systemic lupus erythematosus is associated with a reduced risk for cardiovascular events, including ischemic stroke and myocardial infarction, according to data.
“Use of [hydroxychloroquine (HCQ)] has been associated with reductions in multiple established risk factors for cardiovascular-metabolic endpoints,” April Jorge, MD, of Massachusetts General Hospital, in Boston, and colleagues wrote in Arthritis Care & Research. “Multiple observational studies have demonstrated a reduction in hyperglycemia and a lower risk of developing diabetes mellitus among patients with SLE and RA who are treated with HCQ. Its use has also been associated with improved lipid profiles in SLE and RA patients.
“Furthermore, HCQ use has been associated with a lower risk of venous thromboembolism among patients with SLE in several small studies,” they added. “However, it is not well established whether HCQ use can prevent other [cardiovascular (CV)] events.”
To analyze the temporal link between hydroxychloroquine use and cardiovascular events among patients with SLE or RA, Jorge and colleagues conducted a nested case-control study within population-based inception cohorts of participants with either disease. For their source population, the researchers used linked administrative health databases from Population Data BC, which includes demographic and health care information on the entire population of British Columbia, Canada — more than 5 million people.
From these databases, the researchers identified 6,241 adults with SLE and 64,012 with RA. The researchers then identified from these cohorts’ patients with incident cardiovascular events, including myocardial infarction, stroke or venous thromboembolism. Each case was matched with up to three control patients without incident cardiovascular event based on age, sex and rheumatic disease. In all, the researchers identified 10,268 patients with cardiovascular events and 29,969 without.
Jorge and colleagues characterized hydroxychloroquine use based on the time between the last prescription date covered and the index date. Patients were current users if they had an active supply of the drug spanning the index date, or if their supply ended within a 90-day grace period before the index date. Recent use was defined as a hydroxychloroquine supply ending between 91 and 365 days prior to the index date, while patients were remote users if their supply ended more than 365 days prior to the index date. Patients were classified as never users if they had no dispensed hydroxychloroquine prescriptions.
According to the researchers, adjusted conditional ORs for current hydroxychloroquine use, compared with remote users, were 0.86 (95% CI, 0.77-0.97) for combined cardiovascular events, 0.88 (95% CI, 0.74-1.05) for myocardial infarction, 0.87 (95% CI, 0.74-1.03) for stroke and 0.74 (95% CI, 0.59-0.94) for venous thromboembolism. Meanwhile, recent (cOR = 0.93; 95% CI, 0.77-1.13) and never (cOR = 0.96; 95% CI, 0.88-1.04) users demonstrated similar odds of combined cardiovascular events as remote users.
“We observed a lower risk of overall CV events as well as a lower risk of [venous thromboembolism] and a trend towards lower risks for [myocardial infarction] and ischemic stroke associated with current HCQ use,” Jorge and colleagues wrote. “These associations were also observed in the larger RA subgroup, but we did not observe a significant difference in the odds of CV events according to HCQ use status within the smaller SLE subgroup.
“Overall, we found lower risks of CV events associated with current HCQ use in a combined cohort of SLE and RA patients in a general population context,” they added. “These findings support possible protective effects of this medication for patients with SLE and RA.”