Hydroxychloroquine Use and 5-Year Cardiometabolic Profile and Cardiovascular Risk in Isolated Discoid Lupus Erythematosus: A Retrospective Cohort Study.

Abstract

Discoid lupus erythematosus (DLE) is associated with systemic inflammation and increased cardiovascular disease (CVD) risk. Hydroxychloroquine (HCQ) has cardioprotective effects in systemic lupus but its impact in isolated DLE is unknown. To evaluate whether HCQ initiation in adults with isolated DLE is associated with lower 5-year cardiometabolic and cardiovascular risk. We conducted a single-center retrospective cohort study of 106 adults with isolated DLE and a multi-institutional TriNetX cohort study (2,260 propensity-matched pairs). Patients were categorized as HCQ users or HCQ-naïve. Outcomes included 5-year incidence of hypertension, hyperlipidemia, diabetes, coronary artery disease (CAD), peripheral arterial disease (PAD), angina, myocardial infarction, stroke, and major adverse cardiovascular events (MACE). Multivariable logistic regression and matched risk ratios were used. In the single-center cohort, HCQ use was associated with significantly lower odds of hyperlipidemia, PAD, angina, and CAD, regardless of DLE extent. In TriNetX, HCQ use was associated with significantly reduced risk of hypertension, hyperlipidemia, diabetes, CAD, and stroke. Retrospective design, residual confounding, reliance on ICD-10 coding, and limited assessment of disease activity. HCQ initiation in isolated DLE within our institution and the TriNetX database was associated with lower 5-year cardiometabolic and atherosclerotic risk, supporting its early use for potential cardiovascular risk mitigation.