SLE was associated with about two and a half times the risk of stroke, both ischaemic and haemorrhagic

Design

Systematic review and meta-analysis of cohort studies

Population

25 cohorts, 5,220,837 individuals

Primary outcome

Stroke risk in SLE vs non-SLE

Effect

RR 2.60 (2.21 to 3.05); ischaemic 2.34 (1.75 to 3.12); haemorrhagic 2.66 (1.57 to 4.49)

This meta-analysis pooled 25 cohort studies (5.2 million people, published 2001 to 2026) comparing stroke risk in people with and without SLE.

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

Stroke in lupus has several drivers: accelerated atherosclerosis, antiphospholipid antibodies, hypertension from renal disease, glucocorticoids and vasculitis. The practical change is to treat stroke prevention as part of lupus care from diagnosis — not something left to primary care once the disease is quiet.

• Check antiphospholipid antibodies in every patient with SLE, and repeat if positive
• Measure and treat blood pressure and lipids at rheumatology visits
• Minimise glucocorticoid exposure; aim for 5 mg prednisolone or less
• Advise on smoking cessation and oestrogen-containing contraception risk
• Treat new neurological symptoms in SLE as possible stroke and image urgently

Why it matters

Cardiovascular risk in lupus is easily overshadowed by disease activity until it causes a stroke.

Don't overread it

Observational cohorts with very high heterogeneity; the size of the increase varies between populations.

The statistics, in plain English

A risk ratio of 2.6 means about two and a half times the risk. I² near 98% means the individual studies differed widely in their estimates, although all pointed the same way.

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