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Research ArticleAccepted Article

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 August 2022, jrheum.220279; DOI: https://doi.org/10.3899/jrheum.220279
Shivani Garg
University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; Emory University School of Medicine, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Division of Population Health; Emory University Rollins School of Public Health, Department of Epidemiology. No conflict of interest. The Georgians Organized Against Lupus (GOAL) Cohort was supported by 3U58DP001487-05W2 and U01DP05119 (Centers for Disease Control and Prevention). Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This study was presented at Plenary Session-I at the Annual American College of Rheumatology Meeting in Atlanta, November 2019. Address correspondence to Shivani Garg, MD MS, Assistant Professor, Dept. of Medicine, Rheumatology Division, University of Wisconsin School of Medicine & Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705. sgarg@medicine.wisc.edu
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Christie M. Bartels
University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; Emory University School of Medicine, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Division of Population Health; Emory University Rollins School of Public Health, Department of Epidemiology. No conflict of interest. The Georgians Organized Against Lupus (GOAL) Cohort was supported by 3U58DP001487-05W2 and U01DP05119 (Centers for Disease Control and Prevention). Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This study was presented at Plenary Session-I at the Annual American College of Rheumatology Meeting in Atlanta, November 2019. Address correspondence to Shivani Garg, MD MS, Assistant Professor, Dept. of Medicine, Rheumatology Division, University of Wisconsin School of Medicine & Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705. sgarg@medicine.wisc.edu
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Gaobin Bao
University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; Emory University School of Medicine, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Division of Population Health; Emory University Rollins School of Public Health, Department of Epidemiology. No conflict of interest. The Georgians Organized Against Lupus (GOAL) Cohort was supported by 3U58DP001487-05W2 and U01DP05119 (Centers for Disease Control and Prevention). Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This study was presented at Plenary Session-I at the Annual American College of Rheumatology Meeting in Atlanta, November 2019. Address correspondence to Shivani Garg, MD MS, Assistant Professor, Dept. of Medicine, Rheumatology Division, University of Wisconsin School of Medicine & Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705. sgarg@medicine.wisc.edu
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Charles G. Helmick
University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; Emory University School of Medicine, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Division of Population Health; Emory University Rollins School of Public Health, Department of Epidemiology. No conflict of interest. The Georgians Organized Against Lupus (GOAL) Cohort was supported by 3U58DP001487-05W2 and U01DP05119 (Centers for Disease Control and Prevention). Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This study was presented at Plenary Session-I at the Annual American College of Rheumatology Meeting in Atlanta, November 2019. Address correspondence to Shivani Garg, MD MS, Assistant Professor, Dept. of Medicine, Rheumatology Division, University of Wisconsin School of Medicine & Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705. sgarg@medicine.wisc.edu
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Cristina Drenkard
University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; Emory University School of Medicine, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Division of Population Health; Emory University Rollins School of Public Health, Department of Epidemiology. No conflict of interest. The Georgians Organized Against Lupus (GOAL) Cohort was supported by 3U58DP001487-05W2 and U01DP05119 (Centers for Disease Control and Prevention). Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This study was presented at Plenary Session-I at the Annual American College of Rheumatology Meeting in Atlanta, November 2019. Address correspondence to Shivani Garg, MD MS, Assistant Professor, Dept. of Medicine, Rheumatology Division, University of Wisconsin School of Medicine & Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705. sgarg@medicine.wisc.edu
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S. Sam Lim
University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; Emory University School of Medicine, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Division of Population Health; Emory University Rollins School of Public Health, Department of Epidemiology. No conflict of interest. The Georgians Organized Against Lupus (GOAL) Cohort was supported by 3U58DP001487-05W2 and U01DP05119 (Centers for Disease Control and Prevention). Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This study was presented at Plenary Session-I at the Annual American College of Rheumatology Meeting in Atlanta, November 2019. Address correspondence to Shivani Garg, MD MS, Assistant Professor, Dept. of Medicine, Rheumatology Division, University of Wisconsin School of Medicine & Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705. sgarg@medicine.wisc.edu
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Abstract

Objective Systemic lupus erythematosus (SLE) affects Black people two to three times more frequently than non-Black people and is associated with higher morbidity and mortality. Four 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 was over a 15-year period, starting from two years prior to SLE diagnosis.

Results Among 336 people with SLE (75% Black), 56 (17%) had an incident CVD event. The frequency of CVD events peaked in the second and eleventh year after SLE diagnosis. There was 7-fold higher risk of incident CVD over the entire 15-year period, 19-fold in the first 12 years, in Black compared to non-Black people with SLE. Black people with SLE (p<0.0001) and those with discoid rash (HR 3.2, 95% CI 1.4-7.1) had higher risk of incident CVD events.

Conclusion The frequency of incident CVD events peaked in the second and the eleventh year 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 towards Black people with recent SLE diagnoses, are needed to reduce racial disparities.

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The Journal of Rheumatology
Vol. 50, Issue 3
1 Mar 2023
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Accepted manuscript
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 Aug 2022, jrheum.220279; DOI: 10.3899/jrheum.220279

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Accepted manuscript
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 Aug 2022, jrheum.220279; DOI: 10.3899/jrheum.220279
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