Systemic lupus erythematosus linked to increased risk for stroke

A systematic review and meta-analysis of 25 cohort studies, published in *Lupus Science & Medicine* and led by Jingya Zhang of Zhejiang Chinese Medical University, links systemic lupus erythematosus (SLE) to a significantly increased risk for all stroke subtypes. Analyzing over 5.2 million individuals, the study reveals that SLE patients face a pooled risk ratio of 2.60 for any stroke, including elevated risks for both ischemic and hemorrhagic strokes, confirming SLE as an independent risk factor.

SLE stroke risk meta-analysis

• ▪The authors of the *Lupus Science & Medicine* study concluded that systemic lupus erythematosus represents an independent and substantial risk factor for all stroke subtypes.
• ▪The meta-analysis of 25 cohort studies on systemic lupus erythematosus and stroke risk included 5,220,837 individuals, comprising 1,408,205 patients with systemic lupus erythematosus and 3,812,632 control individuals.
• ▪A systematic review and meta-analysis published in *Lupus Science & Medicine* on September 15, 2026, linked systemic lupus erythematosus to an increased risk for stroke.

Stroke subtype risk quantification

• ▪The meta-analysis found that patients with systemic lupus erythematosus had a significantly increased risk for any stroke, with a pooled risk ratio of 2.60.
• ▪The meta-analysis showed that systemic lupus erythematosus was associated with an increased risk for ischemic stroke, with a pooled risk ratio of 2.34, and hemorrhagic stroke, with a pooled risk ratio of 2.66.
• ▪Systemic lupus erythematosus was associated with an increased risk for composite stroke, showing a pooled risk ratio of 2.83 across 15 studies in the meta-analysis.

Study methodology

• ▪The systematic review and meta-analysis on systemic lupus erythematosus and stroke risk was led by Jingya Zhang of Zhejiang Chinese Medical University in Hangzhou, China.
• ▪The study on systemic lupus erythematosus and stroke risk was supported by the National Natural Science Foundation of China and the National Natural Science Foundation of China Joint Fund for Regional Innovation and Development.

Study quality assessment

• ▪Most cohort studies in the systemic lupus erythematosus meta-analysis adjusted for major cardiovascular risk factors, though the authors noted that residual confounding may have persisted.
• ▪Researchers assessed the quality of the 25 cohort studies in the meta-analysis using the Newcastle-Ottawa Quality Assessment Scale, finding seven studies of moderate quality and 18 of high quality.

Study limitations

• ▪The definitions of systemic lupus erythematosus and stroke in the meta-analysis relied on administrative codes, which the authors noted may have caused misclassification.
• ▪Hemorrhagic stroke was reported in only eight studies in the systemic lupus erythematosus meta-analysis, which limited the precision of the risk estimate.
• ▪A subgroup analysis by lupus nephritis status was not conducted in the systemic lupus erythematosus meta-analysis because only two studies provided the specific data.