Risk for stroke three times higher among Black patients with lupus
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Among Black patients with lupus, the risk for stroke is three times higher than white patients, and the risk for ischemic heart disease is 24 times higher, according to a presenter at ACR Convergence 2020 virtual meeting.
“The risk for developing cardiovascular disease is up to 52 times higher in patients with lupus, compared to patients without lupus,” Shivani Garg, MD, MS, assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health, told Healio Rheumatology. “Black populations have three times higher risk to develop lupus, develop it at a significantly younger age and have more severe disease.”
“However, most prior lupus and cardiovascular disease studies were conducted in predominantly white cohorts, limiting the generalizability of the findings,” she added. “It’s important to quantify the risk, predictors and timing of stroke and ischemic heart disease in Black people with lupus in order to guide early CVD diagnosis and preventive interventions in this at-risk population.”
At the 2019 ACR/ARP Annual Meeting, Garg reported that CV events related to systemic lupus erythematosus peak at 1 to 2 years following diagnosis, with an 18-fold higher risk among black patients with SLE compared with white patients.
This year, Garg and colleagues again used data from the Georgia Lupus Registry, one of the largest and most racially diverse lupus cohorts, to measure the risk and predictors of stroke and ischemic heart disease among 336 patients with incident SLE, of whom 75% were Black and 87% were women. The first three admission or cause of death codes were used to classify hospitalizations due to stroke (including transient ischemic attack) or ischemic heart disease (including myocardial infarction and angina). Garg and colleagues used Cox proportional hazards models to analyze predictors of stroke and ischemic heart disease.
From 2 years prior to SLE diagnosis through 14 years after, 38 stroke-related and 25 ischemic heart disease-related events or deaths occurred.
Among patients with stroke (11%), 90% were Black, 78% were female and the mean age at first event was 48 years. Similar to their findings presented last year, Garg reported the number of strokes peaked in the second year after SLE diagnosis. Ischemic heart disease occurred in 8% of patients, all of whom were women and 96% of whom were Black. The mean age after the first event was 52 years, and the peak number of events occurred in the 14th year after SLE diagnosis, according to Garg.
The risks for stroke and ischemic heart disease among Black patients were three-fold (HR = 3.4; 95% CI, 1.2-10) and 24-fold higher (HR = 24; 95% CI, 3-206), respectively. Additionally, at SLE diagnosis, a discoid rash predicted a five-fold higher risk for stroke (HR = 4.6; 95% CI, 1.7-13) and renal disorder predicted a two-fold higher risk for stroke (HR = 2.4; 95% CI, 1.1-2.5). Conversely, they had no effect on ischemic heart disease risk, but rather the presence of neurologic and immunologic disorder strongly predicted ischemic heart disease (HR = 4.0; 95%, CI 1.3-13 for neurologic and HR = 4.7; 95% CI, 1.3-18 for immunologic), but not stroke.
Stroke and ischemic heart disease events were significantly accelerated in Black vs. non-Black patients, according to race stratified Cox proportional hazard models (P .001).
“This study provides unique insights on significantly different SLE-disease related predictors, timing and racial disparities in stroke compared to IHD in SLE,” Garg said. “Hence, we highlight the need to consider different preventive strategies for stroke and IHD in SLE.”
Perspective
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Emily Littlejohn, DO, MPH
These data underscore the importance of keeping close attention to modifiable cardiac and atherosclerotic risk in our Black patients with SLE. This includes monitoring of blood pressures and cholesterol, attention to diet, weight management and medication compliance. As providers, our care needs to extend beyond the realm of just lupus activity but also needs to include engagement in preventative medicine.
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Garg S. Abstract #0433. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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