Early HCQS Use Lowers Cardiometabolic Risk in Discoid Lupus: Study
USA: New data suggest that early initiation of hydroxychloroquine in patients with discoid lupus erythematosus is associated with a reduced 5-year risk of cardiometabolic and atherosclerotic events. These findings extend the well-established cardiovascular benefits of hydroxychloroquine in systemic lupus erythematosus to patients with isolated discoid lupus, supporting early treatment to improve long-term cardiovascular health.
Discoid lupus erythematosus (DLE) is a chronic inflammatory skin disease that has been linked to an increased risk of cardiovascular and metabolic disorders. While hydroxychloroquine (HCQ) has shown cardioprotective effects in systemic lupus erythematosus, its impact in isolated DLE has not been well studied.
To investigate this, researchers led by Anjana Srikumar from Johns Hopkins University School of Medicine conducted a retrospective cohort study, published in the Journal of the American Academy of Dermatology (JAAD), evaluating the association between HCQ use and long-term cardiometabolic outcomes in adults with isolated DLE.
The study included a single-center cohort of 106 patients with isolated DLE and a multi-institutional TriNetX cohort comprising 2,260 propensity score-matched pairs of HCQ users and non-users. The researchers assessed the 5-year incidence of hypertension, hyperlipidemia, diabetes, coronary artery disease, peripheral arterial disease, angina, myocardial infarction, stroke, and major adverse cardiovascular events using multivariable and matched analyses.
The study revealed the following findings:
- Hydroxychloroquine use was associated with a lower 5-year risk of several cardiometabolic and cardiovascular conditions in patients with isolated discoid lupus erythematosus.
- Patients treated with hydroxychloroquine had significantly lower odds of developing hyperlipidemia.
- Hydroxychloroquine use was linked to a reduced risk of peripheral arterial disease.
- Patients receiving hydroxychloroquine were less likely to develop angina.
- The treatment was associated with lower odds of coronary artery disease.
- These cardiovascular benefits were observed regardless of the extent of discoid lupus skin involvement.
- In the larger TriNetX cohort, hydroxychloroquine use was associated with a significantly lower risk of hypertension.
- Patients receiving hydroxychloroquine had a reduced risk of developing diabetes.
- Hydroxychloroquine-treated patients also had a lower risk of stroke during the 5-year follow-up period
The authors acknowledged limitations, including the retrospective design, potential residual confounding, reliance on ICD-10 coding, and limited assessment of disease activity. Despite these constraints, the findings suggest that hydroxychloroquine may provide benefits beyond skin disease management.
Despite these limitations, the study suggests that hydroxychloroquine may offer benefits beyond skin disease control in patients with isolated DLE. The researchers concluded that HCQ initiation was associated with a lower five-year risk of cardiometabolic and atherosclerotic outcomes across both institutional and large-scale database cohorts, supporting consideration of early treatment as a strategy for long-term cardiovascular risk reduction in this patient population.
Reference:
Srikumar, A., Yuvchenko, O., & Kang, J. (2026). Hydroxychloroquine use and 5-year cardiometabolic profile and cardiovascular risk in isolated discoid lupus erythematosus: A retrospective cohort study. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2026.04.022
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