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Research ArticleArticle

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
The Georgians Organized Against Lupus (GOAL) Cohort was supported by the Centers for Disease Control and Prevention (CDC; 3U58DP001487- 05W2 and U01DP05119). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. S. 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; G. Bao, MPH, Senior Statistician, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; C.G. Helmick, MD, Professor, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; C. 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. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Garg, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705, USA. Email: sgarg@medicine.wisc.edu. Accepted for publication July 20, 2022.
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Christie M. Bartels
The Georgians Organized Against Lupus (GOAL) Cohort was supported by the Centers for Disease Control and Prevention (CDC; 3U58DP001487- 05W2 and U01DP05119). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. S. 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; G. Bao, MPH, Senior Statistician, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; C.G. Helmick, MD, Professor, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; C. 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. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Garg, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705, USA. Email: sgarg@medicine.wisc.edu. Accepted for publication July 20, 2022.
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Gaobin Bao
The Georgians Organized Against Lupus (GOAL) Cohort was supported by the Centers for Disease Control and Prevention (CDC; 3U58DP001487- 05W2 and U01DP05119). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. S. 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; G. Bao, MPH, Senior Statistician, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; C.G. Helmick, MD, Professor, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; C. 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. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Garg, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705, USA. Email: sgarg@medicine.wisc.edu. Accepted for publication July 20, 2022.
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Charles G. Helmick
The Georgians Organized Against Lupus (GOAL) Cohort was supported by the Centers for Disease Control and Prevention (CDC; 3U58DP001487- 05W2 and U01DP05119). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. S. 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; G. Bao, MPH, Senior Statistician, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; C.G. Helmick, MD, Professor, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; C. 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. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Garg, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705, USA. Email: sgarg@medicine.wisc.edu. Accepted for publication July 20, 2022.
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Cristina Drenkard
The Georgians Organized Against Lupus (GOAL) Cohort was supported by the Centers for Disease Control and Prevention (CDC; 3U58DP001487- 05W2 and U01DP05119). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. S. 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; G. Bao, MPH, Senior Statistician, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; C.G. Helmick, MD, Professor, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; C. 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. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Garg, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705, USA. Email: sgarg@medicine.wisc.edu. Accepted for publication July 20, 2022.
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S. Sam Lim
The Georgians Organized Against Lupus (GOAL) Cohort was supported by the Centers for Disease Control and Prevention (CDC; 3U58DP001487- 05W2 and U01DP05119). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. S. 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; G. Bao, MPH, Senior Statistician, Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; C.G. Helmick, MD, Professor, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; C. 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. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Garg, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB #4122, Madison, WI 53705, USA. Email: sgarg@medicine.wisc.edu. Accepted for publication July 20, 2022.
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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.

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