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.
