The risk of systematic lupus erythematous may be reduced by almost half by adhering to modifiable healthy lifestyle behaviors according to new research published in Arthritis and Rheumatology.

"Systematic lupus erythematous is a chronic multi system inflammatory autoimmune condition that remains a leading cause of death among young women. It was recently estimated that 200,000 people in the US have SLEC by classification criteria, with prevalence nine times higher among females than males,” May Choi, MD, FRCPC, from the Division Rheumatology and Department of Medicine at the Cumming School of Medicine at the University of Calgary, and colleagues wrote in the study. “Although the mortality risk in SLE patients has decreased substantially over the past few decades, many will still experience progressive and/or complicated disease, underscoring the public health impact of SLE and the importance of disease prevention research given that few effective medical therapies are available.”

Although previous studies have been conducted to evaluate the link between individual factors related to lifestyle and the risk of, it is unclear how the combination of these factors might affect the risk of incident SLE. To evaluate whether a combination of healthy lifestyle factors is associated with lower risk of incident SLE and its subtypes, Choi and colleagues conducted a prospective study made up of 185,962 women with 203 incident SLE cases (96 anti-dsDNA positive, 107 anti-dsDNA negative) during 4,649,477 person-years of follow-up from the Nurses’ Health Study (NHS) and NHSII cohorts.

The researchers calculated the Healthy Lifestyle Index Score (HLIS) at baseline and approximately every 2 years in follow-up using five factors: alcohol consumption, body mass index, smoking, diet, and exercise. 

A time-varying Cox hazards regression model estimated the adjusted HR for SLE risk and the researchers also calculated the partial population attributable risk (PAR%) of SLE development.

According to the results of the study, there was a link between higher HLIS and lower overall risk for SLE (HR = 0.81; 95%CI, 0.71-0.94) and dsDNA positive SLE (HR = 0.78; 95%CI, 0.63-0.95). 

The researchers found that women with four or more healthy factors had the lowest SLE risk overall (HR = 0.42; 95%CI 0.25-0.70) and dsDNA positive SLE (HR = 0.35; 95%CI 0.17-0.75) compared to women with less than or equal to one healthy behavior, according to the researchers. 

Additionally, the researchers found the PAR% for SLE from adhering to four or more healthy behaviors was 47.7% (95%CI 23.1-66.6).

“We found an inverse association between a combination of healthy lifestyle behaviors and SLE risk, associated with nearly half of the population attributable risk. Our findings have implications for SLE prevention and the promotion of multiple lifestyle behaviors to derive the greatest benefit,” the researchers wrote.  “We also provided further insight into the pathogenesis of SLE as a greater than expected proportion of SLE risk may be attributable to modifiable lifestyle factors.”

Disclosure: The authors report no relevant financial disclosures.