African-Americans with Lupus and Like Diseases Appear at Higher Risk of Cardiovascular Disease

Research conducted on medical records from over a quarter million adult patients found that African-Americans with connective tissue diseases were twice as likely to suffer complications that increase the risk of a heart attack, stroke, or death. The study, “The Prevalence of Atherosclerosis in Those with Inflammatory Connective Tissue Disease by Race, Age, and Traditional Risk Factors” published in the journal Scientific Reports, also revealed the prevalence of narrowed blood vessels in patients with connective tissues diseases was especially high in young African-Americans.

“These findings raise new questions about the links between inflammation, connective tissue diseases and atherosclerotic cardiovascular disease,” the study author, Francis Alenghat, MD, PhD, assistant professor of medicine in the section of cardiology at the University of Chicago, said in a news release. “They point to differences in heart disease risk tied to systemic inflammation and modified by race and age.”

Systemic inflammation is known to promote cardiovascular disease, and inflammatory connective tissue diseases (CTD) like lupus and rheumatoid arthritis are associated with cardiovascular risk. But less certain is whether particular groups of CTD patients have an enhanced and associated risk for atherosclerotic cardiovascular disease (ASCVD).

In fact, there was “a dearth of formal understanding on interactions of race with connective tissue diseases in determining cardiovascular risk,” said Dr. Alenghat. To better determine and understand these interactions, Dr. Alenghat turned to “the large, diverse patient population seen here at the University of Chicago.”

The study utilized medical charts and information from 287,000 African-American and Caucasian patients treated at the university’s medical center. In total, results revealed that 10 percent of African-American patients had atherosclerotic cardiovascular disease, compared to a 8.4 percent of white patients. Atherosclerotic cardiovascular disease included heart attack, ischemic heart disease, angina, coronary artery disease, or atherosclerotic disease in any artery.

The study included 8,747 patients with lupus or another type of connective tissue disease. Overall, people with connective tissue disease had an increased risk of cardiovascular disease, which further increased if they were African-American.

Almost 30 percent of African-Americans with connective tissue disease were found to also have cardiovascular disease, three times as many as African-Americans without CTD. In contrast, 15 percent of Caucasians with connective tissue disease had cardiovascular disease, for a 1.8 times greater incidence than those without the disease. African-Americans with connective tissue disease also developed cardiovascular disease at a younger age than Caucasian CTD patients (9 percent were ages 18–44), and they were 4.7 times more likely to have atherosclerosis than Caucasian patients of comparative age.

“The molecular and cellular causes of each connective tissue disease are distinct,” Dr. Alenghat said. “But they all involve systemic inflammation.” The data from this study suggests “we should consider lower thresholds for primary prevention in many patients with CTD,” he added.

Although the study had some limitations, “the findings show that CTD is associated with higher prevalence of atherosclerotic cardiovascular disease, an association that is accentuated in African-Americans and in young adults. These insights could be used to improve how we evaluate many patients with a wide range of connective tissue diseases,” Dr. Alenghat said.

The results also support the importance of controlling inflammation, and identifying and addressing traditional cardiovascular risks factors. “If we were to view the current findings on the backdrop of contemporary cardiovascular risk calculators and statin guidelines, many patients with connective tissue disease could reasonably consider moderate-intensity statin therapy at age 35,” he said.