Editorial theme | Has the bimodal mortality pattern of SLE evolved in recent years?

The Lupus Hub was pleased to speak to Murray Urowitz, University of Toronto, Toronto, CA. We asked him to revisit his paper on the concept of a bimodal mortality pattern in systemic lupus erythematosus (SLE), first published in 1976,¹ and to discuss how trends have evolved over time.

Urowitz discusses the inception of the bimodal mortality pattern concept in SLE, where early deaths were linked to active lupus, treatment complications, and infections, whereas later deaths often involved coronary artery disease as a prevalent comorbidity. Then, he emphasizes the importance of recognizing subclinical and preclinical forms of the disease and early intervention. Notably, advancements in managing traditional risk factors, such as smoking; improved medications, for treating conditions like hypertension and diabetes; and improved disease control have resulted in at least a threefold decrease in atherosclerotic disease since the 1970s and 80s.