403 Trends in incidence and prevalence of atherosclerotic cardiovascular disease among patients with cutaneous lupus erythematosus from 2018–2020

Background Autoimmune disease such as systemic lupus erythematosus (SLE) and psoriasis have been previously associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), though whether similar increased ASCVD risk is seen with cutaneous lupus (CLE) remains unclear. Thus, we sought to evaluate the prevalence and incidence of ASCVD among those with CLE, SLE, and psoriasis compared with disease-free controls. Methods We performed a retrospective, longitudinal cohort study using outpatient and inpatient encounters claims data from the IBM® MarketScan® Commercial Claims database from January 2018 to December 2020. Our inclusion criteria included adults age ≥18 years with at least 1 year of continuous enrollment in the dataset. Within this population, we identified adults with CLE, SLE, and psoriasis based on the following International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes: CLE using L93, SLE using M32, and psoriasis using L40. CLE was further classified by subtypes: DLE (L93.0), SCLE (L93.1) and other CLE (L93.2). The control population included persons free of CLE, SLE, and psoriasis, matched 10:1 with the CLE population on age, sex, insurance type, and enrollment duration. Prevalent ASCVD was defined as coronary artery disease (CAD, I20 and I25), prior myocardial infarction (MI, I21 and I22), or cerebrovascular accident (CVA, I63 and select G43). Incident ASCVD (hospitalization for CAD, MI, or CVA) was assessed through the end of follow up (up to 2 years and 11 months) in each group. Multivariable logistic regression and Cox- proportional hazards modeling was performed to compare prevalence and incidence of ASCVD between groups adjusting for age, sex, and cardiovascular risk factors. Results We identified 8,138 persons with CLE (median age 49, 81% women), 24,675 persons with SLE, 192,577 persons with psoriasis, and 81,380 controls (figure 1, table 1). The prevalence of ASCVD was 2.24% (95% CI, 1.93–2.59%) for CLE, 2.06% (1.89–2.25 %) for SLE, 1.44% (1.39–1.50%) for psoriasis, and 0.19% (0.16–0.22%) for controls. In multivariable analysis, the odds of ASCVD were higher than control for CLE (OR 1.72, 1.45–2.02) and SLE (OR 2.41, 95% CI 2.14–2.70), but not psoriasis (OR 1.03, 95% CI 0.95–1.11) (figure 2). At median 36 months follow-up, the incidence of ASCVD in CLE was 15.2 (13.1–17.7) per 1000 person-years (HR vs control 1.32, 95% CI 1.13–1.55), 24.8 (23.3–26.4) per 1000 person-years for SLE (HR vs control 2.23, 95% CI 2.05–2.43), and 14.0 (13.5–14.4) per 1000 person years for psoriasis (HR 1.06, 0.99–1.13) (figure 3). Conclusions and Relevance We found that the prevalence of ASCVD in persons with CLE was similar to that seen in SLE, and higher than that observed in persons with psoriasis. Similarly, after controlling for traditional risk factors for ASCVD, in comparison with a control population, the incidence of newly diagnosed ASCVD was similar in those with CLE and SLE, and higher in those with CLE compared with those with psoriasis. Combined, these data suggest that CLE should be considered as a risk-enhancer for ASCVD and persons with CLE should be targeted for comprehensive cardiovascular risk reduction strategies. Clinicians treating patients with CLE should consider them at increased ASCVD risk and institute appropriate preventive therapies.