Integrative Therapy Combining Chinese Herbal Medicines With Conventional Treatment Reduces the Risk of Cardiovascular Disease Among Patients With Systemic Lupus Erythematosus: A Retrospective Population-Based Cohort Study.

Han-Hua Yu,Chia-Jung Hsieh

doi:10.3389/fphar.2021.737105

Abstract

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that involves multiple systems and organs. Advanced conventional treatment does not appear to markedly reduce the risk of cardiovascular disease (CVD) among patients with SLE. Chinese medicine is a complementary and alternative medicine system, and some SLE patients in Taiwan also use Chinese herbal medicines (CHMs). Thus, we aimed to investigate whether integrative therapy combining CHMs with conventional therapy reduces the risk of CVD among patients with SLE. We performed a 12-years population-based retrospective cohort study using the “Systemic Lupus Erythematosus Health Database” of the National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with SLE between 2004 and 2013 were divided into CHM and non-CHM groups and followed up until the end of 2015. We applied 1:1 individual matching by age, gender, and year of being newly diagnosed with SLE; accordingly, 2,751 patients were included in both CHM and non-CHM groups after matching. We applied the Cox proportional hazard regression model to determine the risk of CVD in relation to CHM use. During the follow-up period, 407 patients in the CHM group and 469 patients in the non-CHM group developed CVD, with incidence rates of 337 and 422 per 10,000 person-years, respectively. The Cox proportional hazards model demonstrated a significantly decreased risk of CVD among SLE patients using CHMs (adjusted HR: 0.83; 95% CI 0.73–0.95; p = 0.008). Further analyses of different types of CVDs also showed a significantly decreased risk of ischemic stroke in the CHM group (adjusted HR: 0.74; 95% CI 0.57–0.97; p = 0.032). Among the frequently used single herbs and polyherbal formulas, Shu-Jing-Huo-Xue-Tang was associated with a significantly decreased risk of CVD (adjusted HR: 0.76; 95% CI 0.58–0.99; p = 0.041). In conclusion, CHM use reduced the risk of CVD among patients with SLE in Taiwan. Further randomized studies may be needed to determine the definite causal relationship between CHM use and its protective effects against CVD among patients with SLE.

Highlights

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease involving multiple systems and organs, and it presents with an unacceptably high morbidity burden and various complications (Golder and Hoi, 2017; Dörner and Furie, 2019; Durcan et al, 2019)
Further analyses of different types of Cardiovascular disease (CVD) demonstrated a significant decrease in the ischemic stroke risk among the SLE patients using Chinese herbal medicines (CHMs)
If we restricted the cumulative days of CHM use to more than 30 days, the hazard ratio (HR) of CVD showed a significant further decrease in the CHM group. This nationwide population-based retrospective cohort study aimed to determine the effect of integrative therapy with CHM on the risk of CVD among patients with SLE in Taiwan

Summary

Introduction

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease involving multiple systems and organs, and it presents with an unacceptably high morbidity burden and various complications (Golder and Hoi, 2017; Dörner and Furie, 2019; Durcan et al, 2019). Survival of SLE patients has improved over the past several decades. The 10-years survival rate exceeds 90%, while the 20-years survival rate has increased to approximately 80% (Doria et al, 2006; Kasitanon et al, 2006; Durcan et al, 2019). This decrease in mortality may be attributable to early diagnosis and advanced treatment (Fors Nieves and Izmirly, 2016). The survival of patients with SLE has not continued to increase throughout the 2000s (Tektonidou et al, 2017)

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