SLE was associated with more than doubled stroke risk, ischaemic and haemorrhagic

Design

Systematic review and meta-analysis of 25 cohort studies

Population

5,220,837 individuals with and without SLE

Primary outcome

Stroke (composite, ischaemic, haemorrhagic)

Effect

Any stroke RR 2.60 (2.21–3.05); ischaemic 2.34 (1.75–3.12); haemorrhagic 2.66 (1.57–4.49)

This meta-analysis pooled 25 cohort studies published between 2001 and 2026, covering 5,220,837 people, to estimate stroke risk in systemic lupus erythematosus against people without it.

SLE was associated with a higher risk of stroke overall (RR 2.60, 95% CI 2.21–3.05). The increase was seen for ischaemic stroke (RR 2.34, 1.75–3.12) and haemorrhagic stroke (RR 2.66, 1.57–4.49). Heterogeneity was very high (I² around 97–98%), but sensitivity analyses gave consistent results and there was little evidence of publication bias.

Lupus patients are often young, so their absolute stroke risk is underestimated by conventional cardiovascular risk calculators, which do not include SLE. The finding that haemorrhagic risk is raised too matters when anticoagulation is being considered. In Indian practice, where hypertension and renal involvement are common in lupus, structured vascular risk review belongs in routine follow-up.

• Assess stroke risk factors at every annual lupus review: blood pressure, lipids, glucose, smoking, renal function
• Test for antiphospholipid antibodies and manage persistently positive patients accordingly
• Treat blood pressure to target, especially in lupus nephritis
• Minimise long-term glucocorticoid dose, which adds to vascular risk
• Ask about transient neurological symptoms and refer promptly

Why it matters

Standard cardiovascular risk scores do not count lupus, so young patients at real stroke risk are routinely missed.

Don't overread it

Observational cohorts with very high heterogeneity — the size of the excess is uncertain, and the study does not show which interventions reduce it.

The statistics, in plain English

A risk ratio of 2.60 means stroke was about two and a half times as common in lupus. I² near 98% means individual studies found very different sizes of effect, so the pooled number is an average across different populations — but all pointed the same way.

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