Black SLE patients at 19 times higher risk of early heart disease

US study says prevention efforts are needed to ease racial disparity in CVD

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by Lindsey Shapiro |

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Black people with systemic lupus erythematosus (SLE) are at a higher risk of developing heart disease — especially in the early years after their diagnosis — compared with non-Black patients, a new U.S. study found.

The risk of cardiovascular disease or CVD was particularly elevated in the first 12 years following diagnosis. In fact, Black patients were found to have a 19 times higher risk of such early heart disease than were people of other races diagnosed with SLE.

“Surveillance for CVD and preventive interventions, directed particularly towards Black people with recent SLE diagnoses, are needed to reduce racial disparities,” the researchers wrote.

The study, “Timing and Predictors of Incident Cardiovascular Disease in Systemic Lupus Erythematosus: Risk Occurs Early and Highlights Racial Disparities,” was published in The Journal of Rheumatology.

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New study of early heart disease focused on Black patients

While SLE can affect anyone, the likelihood of developing the chronic autoimmune disease is about two to three times higher in the Black population, with Black women at particularly high risk.

Moreover, Black patients have been found to experience more severe SLE symptoms, and may have a higher probability of developing certain complications. For example, Black women with lupus are more than three times more likely to develop kidney failure and die compared with other patient groups, according to researchers.

CVD refers to a group of illnesses affecting the heart and blood vessels, such as heart attack or stroke, with heart disease being the leading cause of death among lupus patients.

Although CVD was historically thought to be an SLE complication that develops later in life, more recent studies have found that it is “no longer primarily a late complication of SLE.” However, these studies mainly included non-Black patients.

Now, researchers investigated the timing and predictors of CVD in a mostly Black population of SLE patients living in the metropolitan area of Atlanta, Georgia. Patients were identified from the population-based Georgia Lupus Registry.

Medical records, the Georgia Hospital Discharge Database, and the National Death Index were monitored over a 15-year period, starting from two years before an SLE diagnosis, to identify incidents of CVD among these patients.

Results showed that of 336 SLE patients, 75% of whom were Black, 56 (17%) had a CVD event. The frequency of CVD events peaked at two time points: one during the second year after diagnosis, and the other 11 years later.

Black patients were found overall to be at a higher risk of developing CVD. Specifically, they had a sevenfold greater risk compared with non-Black patients over the 15-year study period.

Our study shows that the risk of cardiovascular disease (CVD) starts early after diagnosis and is strikingly high in Black people with lupus.

The odds of CVD were particularly high early on, in the first 12 years after diagnosis. Overall, Black patients were at a 19 times higher risk during that time period.

Having a red, scaly rash called a discoid rash also was found to be a strong predictor of CVD, raising the odds by 3.2 times. The coin-shaped discoid rash may appear predominately on the face and scalp in some lupus patients.

“Our study shows that the risk of cardiovascular disease (CVD) starts early after diagnosis and is strikingly high in Black people with lupus and those who present with renal disease and discoid rash (a chronic skin presentation of lupus),’’  Shivani Garg, MD, the study’s first author and the director of the Lupus and Lupus Nephritis Clinic at University of Wisconsin (UW) Health, said in a university press release.

According to Garg, a rheumatologist and also an assistant professor of medicine and rheumatology at the UW School of Medicine and Public Health, this study highlights at-risk lupus populations — and the need for more aggressive CVD screening and risk factor management. Such risk factors include smoking and high blood pressure.

The researchers also noted that their findings challenge the idea that CVD is a late-stage complication of SLE.