{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T08:36:16Z","timestamp":1786523776868,"version":"build-2736575974"},"reference-count":11,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["7K23AR084608\u201003"],"award-info":[{"award-number":["7K23AR084608\u201003"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006260","name":"Rheumatology Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006260","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002193","name":"Lupus Foundation of America","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002193","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Hydroxychloroquine (HCQ) is the cornerstone of systemic lupus erythematosus (SLE) management with benefits extending beyond SLE control, including protection against atherosclerotic cardiovascular disease (ASCVD). Although HCQ blood levels reflect recent exposure and long\u2010term intake reflects medication adherence, the impact of longitudinal changes in both measures on ASCVD risk over time remains unclear. We evaluated how HCQ blood levels and long\u2010term intake patterns relate to estimated ASCVD risk at baseline and after one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective longitudinal study, 248 adults with SLE from the Wisconsin cohort (meeting 2019 American College of Rheumatology\/EULAR criteria) taking HCQ and completing baseline and one\u2010year follow\u2010up visits were included. Long\u2010term HCQ intake was estimated using the proportion of days covered (PDC), and whole\u2010blood HCQ levels served as a marker of recent exposure. Ten\u2010year ASCVD risk was calculated at both time points using the PREVENT calculator. Multivariable linear regression assessed associations between HCQ exposure patterns and ASCVD risk. Changes in exposure categories over one year were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with very low HCQ blood levels (&lt;200 ng\/mL) and low long\u2010term intake (PDC &lt;80%) had significantly higher ASCVD risk at baseline (+2.1%) with a mean predicted risk of 6.6%. Those who remained in or transitioned into these low\u2010exposure categories over one year had the highest ASCVD risk at follow\u2010up (5.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maintaining low long\u2010term HCQ intake and very low HCQ blood levels increased ASCVD risk in patients with SLE. Interventions promoting sustained adherence and therapeutic HCQ levels may enhance cardiovascular outcomes and reduce unnecessary preventive therapies.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/acr80128-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80128","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:03:40Z","timestamp":1785755020000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Hydroxychloroquine Blood Levels and Long\u2010Term Hydroxychloroquine Intake Could Lower Atherosclerotic Cardiovascular Disease Risk and Prevent Polypharmacy in Systemic Lupus Erythematosus"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7272-2692","authenticated-orcid":false,"given":"Shivani","family":"Garg","sequence":"first","affiliation":[{"name":"Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale School of Medicine Yale University  New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7506-9166","authenticated-orcid":false,"given":"Murray","family":"Urowitz","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Wisconsin\u2010Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlie","family":"Dentz","sequence":"additional","affiliation":[{"name":"Institute of Medical Science University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niriti","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Institute of Medical Science University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fauzia","family":"Hollnagel","sequence":"additional","affiliation":[{"name":"Institute of Medical Science University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Costedoat\u2010Chalumeau","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Reference Centre for Rare Autoimmune and Autoinflammatory Diseases Cochin Hospital, Assistance Publique\u2010H\u00f4pitaux de Paris (AP\u2010HP); Universit\u00e9 Paris Cit\u00e9 and Universit\u00e9 Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.32190"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.41621"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-020-02291-z"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.70010"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.80020"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2023-001090"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40930"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.067626"},{"issue":"5","key":"e_1_2_6_10_1","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1002\/art.70010","article-title":"Defining optimally safe and effective blood levels of hydroxychloroquine in lupus: an important step toward precision drug monitoring","volume":"78","author":"Garg S","year":"2026","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2022.152042"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.2024-0654"}],"container-title":["Arthritis Care &amp; 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