Abstract 12577: Risk Factors for Heart Failure in Youth and Young Adults With Systemic Lupus Erythematosus

Introduction:The increased relative risk of heart failure (HF) due to systemic lupus erythematosus (SLE) is greatest among youth and young adults, but the etiology is unclear. We identified risk factors for HF in youth and young adults with SLE and evaluated associations between cardiac manifestations of SLE and HF.Methods:Incident SLE cases without antecedent HF were identified using Clinformatics? (OptumInsight, MN) US claims data (2000-2016), and categorized by age of SLE onset (youth 5-25, young adult 25-44). The primary outcome was the first HF diagnosis (ICD9-CM 428.x), with acute-onset (< 6 months after SLE) or delayed-onset presentation. We ran separate multivariable logistic regressions to identify baseline factors associated with acute-onset HF or predictive of delayed-onset HF. Pre-specified interactions by age of SLE onset were assessed using likelihood ratio tests.Results:There were 526 (2%) HF cases among 4112 youth and 21904 young adults with SLE during a median follow-up of 2.5 yrs after SLE diagnosis [IQR 1.4 - 4.5]. 37 (60%) HF diagnoses in youth were acute-onset compared to 35% of adults, and co-occurred with myopericarditis, endocarditis, or valvular insufficiency in 35%, 14%, and 24% of cases, respectively. Nephritis, antiphospholipid antibody syndrome, myopericarditis and valvular disease at SLE presentation were independently associated with delayed-onset HF (Table). The traditional cardiovascular risk factor most strongly associated with delayed-onset HF was hypertension. There were no significant interactions between major SLE manifestations or cardiovascular risk factors and age of SLE onset.Conclusion:In addition to renal disease and hypertension, cardiac manifestations at initial SLE presentation may be a risk factor for heart failure among youth and young adults, and therefore may warrant routine cardiology follow-up. Hypertension remains an important risk factor across all ages and should be managed aggressively.