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Cardiovascular Events in SLE Peak 1-2 Years Post Diagnosis, Highest Risk Among Black Patients
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ATLANTA — The incidence of cardiovascular events related to systemic lupus erythematosus peaks at 1 to 2 years following diagnosis, with an 18-fold higher risk among black patients with SLE compared with white patients, according to a speaker at the 2019 ACR/ARP Annual Meeting.
“In 2014, the first study highlighted that the risk for cardiovascular disease is not just late in lupus, but is significantly early, and even 2 years before lupus diagnosis,” Shivani Garg, MD, MS, of the University of Wisconsin School of Medicine and Public Health, told attendees. “There were two other studies that highlighted a similar risk for CVD complications early in lupus, and even before lupus diagnosis. The biggest limitations of these studies were that most of them were mostly based on white SLE populations, and as we know, black patients with SLE suffer from high incidence, disease presentation, complications and mortality, therefore the generalizability of these findings is limited.”
To analyze the risk for cardiovascular disease predictors and events among a cohort or mostly African American individuals, Garg and colleagues studied data from the Georgia Lupus Registry (GLR), a population-based registry of patients with SLE in Atlanta. The study included 336 patients with incident SLE, of whom 75% were African American and 87% were women. Cardiovascular disease events or deaths included ischemic heart disease, cerebrovascular accident, transient ischemic attack and peripheral vascular disease.
The researchers analyzed 14 years if data, starting from 2 years before patients’ diagnosis. Each included patient was matched to control individuals in the Georgia Hospital Discharge Database and National Death Index, from 2000 to 2013. Hospitalizations and deaths related to cardiovascular disease events were classified by the first three admission or cause-of-death codes. Garg and colleagues used a Cox proportional hazards model to evaluate predictors of cardiovascular events during this period.
According to the researchers, 31 cardiovascular disease events and five cardiovascular-related deaths occurred during the period from 2 years before to 10 years after SLE diagnosis. In addition, 26 cardiovascular disease events and one cardiovascular-related death were reported from 10 to 14 years following diagnosis. Two cardiovascular disease events occurred beyond the 14-year threshold.
The mean age of SLE diagnosis was 46. The mean age at first cardiovascular disease event during 12 years of follow up, starting 2 years prior to SLE diagnosis, was 48 years. In addition, 91% of events occurred in women, with 75% happening among African American patients.
The mean ages at SLE diagnosis and first cardiovascular event within the 10- to 14-year period following diagnosis were 38 and 52 years, respectively. Here, 70% of events occurred in women and 76% were reported in African American patients.
The researchers determined that African American race predicted a sixfold greater risk for cardiovascular disease events during the follow-up period (adjusted HR = 6.4; 95% CI, 2.4-17.5). In addition, rates of cardiovascular disease events among African American patients were 18-fold higher during the initial 10 years, starting 2 years prior to SLE diagnosis (adjusted HR = 18; 95% CI, 2.2-141).
Other predictors of cardiovascular events were discoid lupus (adjusted HR = 3.2; 95% CI, 1.5-6.8), age older than 65 years (adjusted HR = 7.9; 95% CI, 2.2-29) and the presence of immunological criteria (adjusted HR = 2.1; 95% CI, 1.01-4.4). Using the stratified Cox proportional hazard model, the researchers found significantly accelerated cardiovascular events among the African American population compared with whites (P < .0001).
“The conclusions of this study reveal CVD racial disparities in early SLE, with an 18-fold higher risk in black patients with SLE as compared with white patients, as well as an overall 6-fold higher risk over a 16-year period,” Garg said. “There was significantly accelerated CVD at 1 year after diagnosis, and then again at 10 years after SLE diagnosis. Our findings support the current concept that the risk for cardiovascular disease occurrence is not just late, but significantly early, but now in a diverse lupus cohort.” – by Jason Laday
Reference:
Garg S. Abstract #805. Risk of cardiovascular disease in SLE is significant early and highlights racial disparities. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.
Disclosure: Garg reports no relevant financial disclosures.