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Research ArticleSystemic Sclerosis

Timing and Predictors of Incident Cardiovascular Disease in Systemic Lupus Erythematosus: Risk Occurs Early and Highlights Racial Disparities

Shivani Garg, Christie M. Bartels, Gaobin Bao, Charles G. Helmick, Cristina Drenkard and S. Sam Lim
The Journal of Rheumatology January 2023, 50 (1) 84-92; DOI: https://doi.org/10.3899/jrheum.220279
Shivani Garg
1S. Garg, MD, MS, Assistant Professor, C.M. Bartels, MD, MS, Associate Professor, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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  • For correspondence: sgarg@medicine.wisc.edu
Christie M. Bartels
1S. Garg, MD, MS, Assistant Professor, C.M. Bartels, MD, MS, Associate Professor, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Gaobin Bao
2G. Bao, MPH, Senior Statistician, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia;
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Charles G. Helmick
3C.G. Helmick, MD, Professor, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Cristina Drenkard
4C. Drenkard, MD, PhD, Associate Professor, S.S. Lim, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
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S. Sam Lim
4C. Drenkard, MD, PhD, Associate Professor, S.S. Lim, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
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Abstract

Objective Systemic lupus erythematosus (SLE) affects Black people 2 to 3 times more frequently than non-Black people and is associated with higher morbidity and mortality. In total, 4 studies with predominantly non-Black SLE cohorts highlighted that cardiovascular disease (CVD) is no longer primarily a late complication of SLE. This study assessed the timing and predictors of incident CVD in a predominantly Black population-based SLE cohort.

Methods Incident SLE cases from the population-based Georgia Lupus Registry were validated as having a CVD event through review of medical records and matching with the Georgia Hospital Discharge Database and the National Death Index. The surveillance period for an incident CVD event spanned a 15-year period, starting from 2 years prior to SLE diagnosis.

Results Among 336 people with SLE, 253 (75%) were Black and 56 (17%) had an incident CVD event. The frequency of CVD events peaked in years 2 and 11 after SLE diagnosis. There was a 7-fold higher risk of incident CVD over the entire 15-year period; this risk was 19-fold higher in the first 12 years in Black people as compared to non-Black people with SLE. Black people with SLE (P < 0.001) and those with discoid rash (hazard ratio 3.2, 95% CI 1.4-7.1) had a higher risk of incident CVD events.

Conclusion The frequency of incident CVD events peaked in years 2 and 11 after SLE diagnosis. Being Black or having a discoid rash were strong predictors of an incident CVD event. Surveillance for CVD and preventive interventions, directed particularly toward Black people with recent SLE diagnoses, are needed to reduce racial disparities.

Key Indexing Terms:
  • early risk
  • incident cardiovascular disease
  • predictors
  • racial disparities
  • systemic lupus erythematosus
  • Accepted for publication July 20, 2022.
  • Copyright © 2023 by the Journal of Rheumatology
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1 Jan 2023
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Timing and Predictors of Incident Cardiovascular Disease in Systemic Lupus Erythematosus: Risk Occurs Early and Highlights Racial Disparities
Shivani Garg, Christie M. Bartels, Gaobin Bao, Charles G. Helmick, Cristina Drenkard, S. Sam Lim
The Journal of Rheumatology Jan 2023, 50 (1) 84-92; DOI: 10.3899/jrheum.220279

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Timing and Predictors of Incident Cardiovascular Disease in Systemic Lupus Erythematosus: Risk Occurs Early and Highlights Racial Disparities
Shivani Garg, Christie M. Bartels, Gaobin Bao, Charles G. Helmick, Cristina Drenkard, S. Sam Lim
The Journal of Rheumatology Jan 2023, 50 (1) 84-92; DOI: 10.3899/jrheum.220279
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Keywords

early risk
incident cardiovascular disease
PREDICTORS
racial disparities
SYSTEMIC LUPUS ERYTHEMATOSUS

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Keywords

  • early risk
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  • predictors
  • racial disparities
  • systemic lupus erythematosus

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